Anatomical Substrates of Rapid Eye Movement Sleep Rebound in a Rodent Model of Post-sevoflurane Sleep Disruption

BACKGROUND

Previous research suggests that sevoflurane anesthesia may prevent the brain from accessing rapid eye movement (REM) sleep. If true, then patterns of neural activity observed in REM-on and REM-off neuronal populations during recovery from sevoflurane should resemble those seen after REM sleep deprivation. In this study, the authors hypothesized that, relative to controls, animals exposed to sevoflurane present with a distinct expression pattern of c-Fos, a marker of neuronal activation, in a cluster of nuclei classically associated with REM sleep, and that such expression in sevoflurane-exposed and REM sleep-deprived animals is largely similar.

METHODS

Adult rats and Targeted Recombination in Active Populations mice were implanted with electroencephalographic electrodes for sleep-wake recording and randomized to sevoflurane, REM deprivation, or control conditions. Conventional c-Fos immunohistochemistry and genetically tagged c-Fos labeling were used to quantify activated neurons in a group of REM-associated nuclei in the midbrain and basal forebrain.

RESULTS

REM sleep duration increased during recovery from sevoflurane anesthesia relative to controls (157.0 ± 24.8 min vs. 124.2 ± 27.8 min; P = 0.003) and temporally correlated with increased c-Fos expression in the sublaterodorsal nucleus, a region active during REM sleep (176.0 ± 36.6 cells vs. 58.8 ± 8.7; P = 0.014), and decreased c-Fos expression in the ventrolateral periaqueductal gray, a region that is inactive during REM sleep (34.8 ± 5.3 cells vs. 136.2 ± 19.6; P = 0.001). Fos changes similar to those seen in sevoflurane-exposed mice were observed in REM-deprived animals relative to controls (sublaterodorsal nucleus: 85.0 ± 15.5 cells vs. 23.0 ± 1.2, P = 0.004; ventrolateral periaqueductal gray: 652.8 ± 71.7 cells vs. 889.3 ± 66.8, P = 0.042).

CONCLUSIONS

In rodents recovering from sevoflurane, REM-on and REM-off neuronal activity maps closely resemble those of REM sleep-deprived animals. These findings provide new evidence in support of the idea that sevoflurane does not substitute for endogenous REM sleep.

EDITOR’S PERSPECTIVE

Imaging the Meissner effect in hydride superconductors using quantum sensors

By directly altering microscopic interactions, pressure provides a powerful tuning knob for the exploration of condensed phases and geophysical phenomena1. The megabar regime represents an interesting frontier, in which recent discoveries include high-temperature superconductors, as well as structural and valence phase transitions2-6. However, at such high pressures, many conventional measurement techniques fail. Here we demonstrate the ability to perform local magnetometry inside a diamond anvil cell with sub-micron spatial resolution at megabar pressures. Our approach uses a shallow layer of nitrogen-vacancy colour centres implanted directly within the anvil7-9; crucially, we choose a crystal cut compatible with the intrinsic symmetries of the nitrogen-vacancy centre to enable functionality at megabar pressures. We apply our technique to characterize a recently discovered hydride superconductor, CeH9 (ref. 10). By performing simultaneous magnetometry and electrical transport measurements, we observe the dual signatures of superconductivity: diamagnetism characteristic of the Meissner effect and a sharp drop of the resistance to near zero. By locally mapping both the diamagnetic response and flux trapping, we directly image the geometry of superconducting regions, showing marked inhomogeneities at the micron scale. Our work brings quantum sensing to the megabar frontier and enables the closed-loop optimization of superhydride materials synthesis.

Racial/ ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Despite the global unrelated donor (URD) registry size, the degree to which URD availability is a transplant barrier is not established. We evaluated the availability of 3,843 URDs requested for 455 diverse adult patients (predominantly with acute leukemia). URDs for non-Europeans were more likely to be domestic and had markedly lower Donor Readiness Scores. Of URDs requested for confirmatory HLA-typing (CT) alone (i.e. without simultaneous workup), 1,894/3,529 (54%) were available. Availability of domestic URDs was 45%. Donor Readiness Score was highly predictive of CT availability. Compared with Europeans (n=335), more non-European patients (n=120) had >10 URDs requested and <5 available. Of workup requests (after CT or CT-workup), <70% (604/889, 68%) were available. More non-Europeans had <2 URDs available. URD availability for CT was markedly worse for non-Europeans, with availabilities for African, non-Black Hispanic, and Asian patients of 150/458 (33%), 120/258 (47%) and 119/270 (44%), respectively, with further decrements in URD workup availability. Our data suggest the functional size of the URD pool is much smaller than appreciated, mandating major operational changes for transplant Centers and donor registries. Likelihood of donor availability should have a high priority in donor selection. Considering patient ancestry and URD Donor Readiness Scores, Centers should pursue, and registries permit, simultaneous pursuit of many URDs, and abandon futile searches. Patients should be informed about their likelihood of donor availability and alternative options. Finally, while registries should address high URD attrition and speed procurement, use of all HLA-disparate graft types is needed to facilitate timely transplantation for all.

Plaque Microbiome in Caries-Active and Caries-Free Teeth by Dentition

OBJECTIVE

Describe associations between dental caries and dental plaque microbiome, by dentition and family membership.

METHODS

This cross-sectional analysis included 584 participants in the Center for Oral Health Research in Appalachia Cohort 1 (COHRA1). We sequenced the 16S ribosomal RNA gene (V4 region) of frozen supragingival plaque, collected 10 y prior, from 185 caries-active (enamel and dentinal) and 565 caries-free (no lesions) teeth using the Illumina MiSeq platform. Sequences were filtered using the R DADA2 package and assigned taxonomy using the Human Oral Microbiome Database.

RESULTS

Microbiomes of caries-active and caries-free teeth were most similar in primary dentition and least similar in permanent dentition, but caries-active teeth were significantly less diverse than caries-free teeth in all dentition types. Streptococcus mutans had greater relative abundance in caries-active than caries-free teeth in all dentition types (P < 0.01), as did Veillonella dispar in primary and mixed dentition (P < 0.01). Fusobacterium sp. HMT 203 had significantly higher relative abundance in caries-free than caries-active teeth in all dentition types (P < 0.01). In a linear mixed model adjusted for confounders, the relative abundance of S. mutans was significantly greater in plaque from caries-active than caries-free teeth (P < 0.001), and the relative abundance of Fusobacterium sp. HMT 203 was significantly lower in plaque from caries-active than caries-free teeth (P < 0.001). Adding an effect for family improved model fit for Fusobacterium sp. HMT 203 but notS. mutans.

CONCLUSIONS

The diversity of supragingival plaque composition from caries-active and caries-free teeth changed with dentition, but S. mutans was positively and Fusobacterium sp. HMT 203 was negatively associated with caries regardless of dentition. There was a strong effect of family on the associations of Fusobacterium sp. HMT 203 with the caries-free state, but this was not true for S. mutans and the caries-active state.

KNOWLEDGE TRANSFER STATEMENT

Patients' and dentists' concerns about transmission of bacteria within families causing caries should be tempered by the evidence that some shared bacteria may contribute to good oral health.

Evaluation of food security status, psychological well-being, and stress on BMI and diet-related behaviors among a sample of college students

OBJECTIVES

The purpose of this study was to evaluate food insecurity on body mass index (BMI) and diet-related behaviors among college students and whether psychological well-being (PWB) and stress levels mediate this relationship.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Data from 1439 students from the American College Health Association National College Health Assessment III (Fall 2020) were used. Food security status was evaluated by the USDA Six-Item Short Form. PWB was measured using the Diener Flourishing Scale. Diet-related behaviors included the average servings of fruits, vegetables, and sugar-sweetened beverages consumed per day. Stress was measured by self-reported levels. Regression model analysis evaluated the influence of food security status, PWB, and stress levels on BMI. PWB and stress were also tested as mediators in the relationship between food insecurity and BMI.

RESULTS

Among our sample of college students, 44.54% (n = 641) were food insecure, and 55.46% (n = 798) were food secure. Multiple regression analysis showed that higher food insecurity, older age, full-time enrollment status, and fifth-year student status were positively associated with a higher BMI score (P < 0.05). Results from mediation models revealed that PWB, but not stress, mediated the relationship between food security and BMI among Black/African American students. Regarding diet-related behaviors, high stress levels mediated the relationship between food insecurity and sugar-sweetened beverage intake among students.

CONCLUSIONS

Food insecurity appears to influence BMI in college students. This relationship seems to be mediated by disrupted PWB and a higher intake of sugar-sweetened beverages due to stress.

Excellent leukemia control after second hematopoietic cell transplants with unrelated cord blood grafts for post-transplant relapse in pediatric patients

Background

Patients with leukemia relapse after allogeneic hematopoietic cell transplant (HCT) have poor survival due to toxicity and disease progression. A second HCT often offers the only curative treatment.

Methods

We retrospectively reviewed our bi-institutional experience (MSKCC-USA; Utrecht-NL) with unrelated cord blood transplantation (CBT) for treatment of post-transplant relapse. Overall survival (OS) and event-free survival (EFS) were evaluated using the Kaplan-Meier method, treatment-related mortality (TRM) and relapse were evaluated using the competing risk method by Fine-Gray.

Results

Twenty-six patients age < 21 years received a second (n=24) or third (n=2) HCT with CB grafts during the period 2009-2021. Median age at first HCT (HCT1) was 11.5 (range: 0.9-17.7) years and all patients received myeloablative cytoreduction. Median time from HCT1 to relapse was 12.8 (range 5.5-189) months. At CBT, median patient age was 13.5 (range 1.4-19.1) years. Diagnoses were AML: 13; ALL: 4, MDS: 5, JMML: 2; CML: 1; mixed phenotype acute leukemia: 1. Sixteen patients (62%) were in advanced stage, either CR>2 or with active disease. Median time from HCT1 to CBT was 22.2 (range 7-63.2) months. All patients engrafted after CBT. Thirteen patients developed acute GvHD; 7 had grade III or IV. With a median survivor follow-up of 46.6 (range 17.4-155) months, 3-year OS was 69.2% (95% CI 53.6-89.5%) and 3-year EFS was 64.9% (95% CI 48.8-86.4%). Eight patients died, 3 of AML relapse and 5 due to toxicity (respiratory failure [n=4], GvHD [n=1]) at a median time of 7.7 (range 5.9-14.4) months after CBT. Cumulative incidence of TRM at 3 years was 19.2% (95% CI 4.1-34.4%). Notably, all TRM events occurred in patients transplanted up to 2015; no toxicity-related deaths were seen in the 16 patients who received CBT after 2015. Cumulative incidence of relapse was 15.9% (95% CI 1.6-30.2%) at 3 years, remarkably low for these very high-risk patients.

Conclusions

Survival was very encouraging following CB transplants in pediatric patients with recurrent leukemia after first HCT, and TRM has been low over the last decade. CBT needs to be strongly considered as a relatively safe salvage therapy option for post-transplant relapse.

Equine Gunshot Euthanasia: Creation of a 3D-Printed Model with Integrated Sensors for Training

Challenges and issues related to the use of pentobarbital euthanasia and disposal of animal remains within the US have recently been reviewed. Environmental and public health challenges increasingly necessitate consideration of alternative methods such as gunshots, an American Veterinary Medical Association (AVMA) "acceptable with conditions" method, for the humane euthanasia of horses. A recent study reported a correctly aimed gunshot provides a humane option for euthanizing horses. However, although aiming guidelines exist, studies examining bullet trajectories in animals euthanized by gunshot have reported that inadequate disruption of the brain is a serious welfare issue. Here, we report the development and production of a portable, reusable, equine gunshot euthanasia training model. Using 3D printing, an anatomically accurate model of an equine head has been developed, with external aiming landmarks and equipped with integrated laser sensors and LED eyes. The laser sensors are embedded in two specific anatomical tracts (pons and medulla) with aiming paths associated with the aiming landmarks to train correct aiming angle. The LED eyes are linked to the laser sensors to provide instant feedback on aiming accuracy. When a beam from a commercially available blue training gun laser travels along the correct aiming path and strikes the sensor inside the head, the lights in the model's eyes go out and there is an audible signal, providing immediate feedback on the accuracy of the shot. The model facilitates the training of veterinary personnel and first responders in successful gunshot euthanasia, providing instantaneous feedback on the likelihood of a shot causing immediate, humane death in a live animal.

Analysis of disparities in time to allogeneic transplantation in adults with acute myelogenous leukemia

Although alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLA-identical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.

An Optimized Search Prognosis Tool to Predict 8/8 HLA Allele-Matched Unrelated Donor Procurement

For patients in need of allogeneic transplantation who lack an HLA-identical sibling, an 8/8 HLA allele-matched unrelated donor (URD) is a standard alternative. However, delays in URD procurement can adversely impact patient care. Recipient genotype and search assessment (MSKv1.0)-based tools can predict search prognosis for many, but both tools have lower performance in non-European ancestry patients. Using the MSKv1.0 tool, we analyzed searches from 1530 potential allograft recipients (including 863 who underwent transplantation) with the aim of creating an optimized MSKv2.0 search prognosis tool that can classify a URD search as either Good or Poor with a high level of accuracy while also limiting an ambiguous Fair search prognosis regardless of patient ancestry. By MSKv2.0, the 8/8 URD search prognosis distribution was 57% Good, 21% Fair, and 22% Poor in Europeans and 15% Good, 21% Fair, and 63% Poor in non-Europeans. Importantly, compared to MSKv1.0, the likelihood of Fair categorization was reduced to <25% with comparable Fair rates (P = .847) in both European and non-European groups. Moreover, all patients with an MSKv2.0 Good prognosis had an 8/8 URD identified, and almost all of those who underwent transplantation had an 8/8 URD (Europeans, 99%; non-Europeans, 98%; P = .504). The MSKv2.0 tool also was highly accurate at classifying Poor searches, with <10% identifying an 8/8 URD, and almost all patients who underwent transplantation (Europeans, 95%; non-Europeans, 96%) receiving an alternative donor. Using preliminary search results, MSKv2.0 accurately classifies patients by likelihood of 8/8 URD procurement, greatly facilitating triage to 8/8 URD (Good prognosis) or alternative donor (Poor prognosis) transplantations.

The Effects of Including Lean Unprocessed Beef in a Healthy Vegetarian Dietary Pattern on Cardiometabolic Disease Risk Factors

Objectives

To assess the effects of transitioning a Healthy Vegetarian Dietary Pattern (VEG) to a healthy omnivorous dietary pattern (BEEF) by substituting predominantly starchy vegetables and refined grains with lean unprocessed beef on cardiometabolic disease (CMD) risk factors. We hypothesized that consuming the BEEF would improve CMD risk factors more so than the VEG.

Methods

In a 16-week randomized, crossover, controlled feeding trial, n = 41 subjects (22 female, 19 male; age: 39.9 ± 8.0 y; BMI: 29.6 ± 3.3 kg/m²; mean ± SD) without a diagnosed disease completed two 5-week controlled feeding periods, separated by 5 weeks of consuming self-selected, unrestricted diets (washout). Both dietary patterns were weight maintenance, isocaloric, and US-style healthy eating patterns. The VEG diet was lacto-ovo and the BEEF diet substituted starchy vegetables and refined grains with 6 oz/d of lean unprocessed beef. Baseline and post intervention outcomes included fasting serum lipids, lipoproteins, lipoprotein particle sizes, glucose, insulin; systolic and diastolic blood pressures (SBP and DBP); and waist and hip circumferences (WC and HC). Data are presented as least squares means ± standard error (p < 0.05), adjusted for age, sex, and body mass.

Results

Over time, concentrations of serum total cholesterol (TC), HDL, apolipoprotein A1, small dense LDL IV, and buoyant HDL-2b, TC: HDL, and SBP decreased (p < 0.05), independent of diet. VEG but not BEEF reduced LDL (−10.6 ± 3.0 vs. −5.8 ± 2.9 mg/dL, respectively, intervention x time p = 0.035) and insulin (−1.4 ± 0.5 vs. −0.04 ± 0.5 μIU/mL, respectively, intervention x time p = 0.020). Triglycerides, VLDL, lipoprotein A, apolipoprotein B, remnant lipoprotein, small dense LDL III, glucose, DBP, WC, and HC were not influenced. Post intervention there were no statistical differences between VEG and BEEF for any outcome.

Conclusions

Adopting a US-style Healthy Vegetarian Dietary Pattern or a healthy omnivorous dietary pattern containing lean unprocessed beef improved multiple cardiometabolic disease risk factors among adults classified as overweight or obese.

Funding Sources

The Beef Checkoff.

Effects of Mushroom Consumption on Cardiometabolic Disease Risk Factors: A Systematic Review of Randomized Controlled Trials

Objectives

Mushrooms are edible fungi containing bioactive compounds that may elicit health benefits. This systematic review aimed to assess the effects of whole mushroom consumption on cardiometabolic disease risk factors.

Methods

Three researchers independently screened 700 articles published through July 2021, using searches developed for PubMed, CINAHL, Web of Science, Scopus, and Cochrane Library databases. Inclusion criteria were: English language; subjects aged ≥18 years; comparison of higher vs. lower or no mushroom consumption; reporting ≥1 outcome: diastolic and systolic blood pressure or serum/plasma lipids (total, HDL, and LDL cholesterols, or triglycerides); peer-reviewed RCTs.

Results

We identified 9 RCTs that met our inclusion criteria. The qualified RCTs included the following experimental design features: 6 placebo-controlled, parallel design; 3 non-placebo controlled (post-intervention vs. baseline); 4 included fresh mushrooms, 5 included dried; all 9 provided partial dietary control (i.e. mushrooms only). We found insufficient data to conduct a meta-analysis, therefore, we completed a qualitative assessment of the data. Among the 9 RCTs, mushroom intake did not statistically significantly affect cardiometabolic disease risk factors. The risk factors included systolic or diastolic blood pressures (1/3 studies report a decrease in both); total cholesterol (1/5 studies report a decrease); HDL cholesterol (2/6 studies report an increase); or LDL cholesterol (1/5 studies report a decrease). Four of five studies reported mushroom consumption decreased triglyceride concentrations.

Conclusions

Limited evidence suggests that mushroom consumption may improve serum/plasma triglycerides but not other lipids, lipoproteins, or blood pressures. The paucity of RCTs underscore the need for future research assessing mushrooms for cardiometabolic health, including data to conduct a meta-analysis.

Funding Sources

Mushroom Council funding supported CNU.

Whey Protein Supplementation and Type 2 Diabetes Mellitus Risk Factors: A Scoping Review of Systematic Reviews and/or Meta–Analyses of Randomized Controlled Trials

Objectives

Emerging research on whey protein supplementation WPS suggests it may be a potential modifier of type 2 diabetes mellitus (T2DM) risk factors, including glycemic regulation. As systematic reviews and/or meta-analyses of RCTS are gaining importance in nutrition literature, we conducted a scoping review to systematically search and chronicle published systematic reviews and/or meta-analyses of RCTs pertinent to WPS and T2DM modifiable risk factors.

Methods

The protocol was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Potentially eligible articles were identified via a systematic search of five electronic health research databases (PubMed, Cochrane Library, CINAHL (EBSCO), Scopus, and SPORTDiscus). Included articles were assessed for quality using the AMSTAR-2 critical appraisal tool.

Results

Eight of the 1,692 identified articles met the inclusion criteria. Of the 8 included articles, the outcomes related to T2DM risk factors reported in articles were as follows; 4 included HDL-cholesterol and triglycerides; 3 included fasting blood glucose, total cholesterol, LDL-cholesterol, and body weight; 1 included fasting insulin, HbA1c, blood pressures BMI, and CRP. The results of AMSTAR 2 critical appraisal tool showed that of the 8 included articles, 5 were deemed high quality, 2 were deemed moderate quality, and 1 article was deemed low quality.

Conclusions

Results of the scoping review identified no published systematic reviews and/or meta-analyses of RCTs that provide a comprehensive assessment specifically pertaining to the effects of WPS on T2DM modifiable risk factors. Future systematic reviews and/or meta-analyses of RCTs specifically investigating the effects of WPS on modifiable T2DM risk factors in a comprehensive manner are warranted.

Funding Sources

The Whey Protein Research Consortium

Disparities in speed to BMT consult and allograft in 279 adults with AML

6523

Background: Whether patient (pt) ancestry impacts the time to BMT is not established. Methods: We hypothesized that non-European (non-EURO) ancestry AML pts are at increased risk of delayed time to transplant. Thus, we analyzed time to allograft (Allo) by ancestry defining delayed (late) times as: Allo Indication to BMT Consult (Ind. – Consult) > 90 days, Consult – BMT > 120 days & Allo Indication to BMT (Ind. - BMT) > 180 days. We studied pts < 70 yrs transplanted 1/2016-7/2021. Results: In 279 AML pts (median 56 yrs, range 19-69), BMT indication was date of diagnosis if ELN 2017 intermediate/ high risk &/or high risk mutations &/or sAML in 261 (94%) pts, or date of refractory/ relapsed disease in 18 (6%) pts. European (EURO) pts (n = 195, 70%; median 60 yrs) were older than non-EURO pts (n = 84, 30%; median 49 yrs), p <.001. Most HLA-matched sibling (SIB) (27/33, 82%) & 8/8 HLA-matched unrelated donor (mURD, 113/138, 82%) recipients were EURO; more non-EURO pts received HLA-disparate grafts [cord blood (CB)/ haplo/ mmURD]: 48/84 (57%) vs 55/195 (28%), p <.001. Overall, median (range) times for BMT Ind. - Consult, Consult - BMT, & Ind. - BMT were 45 (1-1127), 86 (13-1628), & 135 (23-1683) days. 15% of pts had late BMT Ind. - Consult, 27% late Consult – BMT, & 28% late Ind. - BMT. In multivariate analysis (significant variables in Table), more older pts had late Consult - BMT & Ind. - BMT; more non-EURO pts had late Ind. - Consult, Consult - BMT & Ind. – BMT; & despite mostly being non-EURO (35/67, 52%), fewer CB recipients had late Consult - BMT. In mURD pts, BMT Ind. - BMT time was delayed in non-EURO (median 182 days) vs EURO (median 128 days) pts (p = 0.04); there was no difference in CB pts (BMT Ind. - BMT EURO pt median 118 vs non-EURO pt median 108 days, p = 0.42). During the pandemic, as compared with EURO pts BMT delays were further exacerbated in non-EURO pts (Ind. - Consult median 13 & Ind. - BMT median 33 days). Conclusions: Few older non-EURO pts are allografted. Matched SIB & 8/8 mURD transplants predominantly serve EURO pts; the majority of non-EURO pts receive HLA-disparate grafts. Older age & non-EURO ancestry are associated with delayed BMT. CB transplants (CBT) are the fastest regardless of ancestry. Finally, the pandemic further exacerbated delays for non-EURO pts. Strategies to mitigate referral barriers (esp. for older non-EURO pts), prompt adult donor evaluations, efficient URD searches, & utilization of all alternative donors are critical to ensure timely BMT for all. Given the rapid availability, CBT should have high priority in high-risk or urgent pts & speedy graft procurement can compensate for late referral. [Table: see text]

0720 Accuracy of WatchPat Portable Sleep Monitoring and Sleep Assessment in Patients with Atrial Fibrillation

Introduction

Obstructive sleep apnea(OSA) is an established risk factor for atrial fibrillation(AF), necessitating early diagnosis and management. Home-based sleep-monitoring technology has become a mainstream diagnostic modality. Peripheral arterial tonometry (PAT) device is increasingly being used to screen for OSA in patients with AF. Our study aimed to examine the accuracy of Watch-PAT (WP) in OSA evaluation, and night-to-night variability of sleep characteristics as measured by WP when used during consecutive night sleep studies.

Methods

Patients with history of AF undergoing clinically indicated PSG were prospectively enrolled and had concurrent WP while undergoing PSG. Patients then were studied again using WP over two consecutive days at home. We compared agreement of OSA severity(defined as no OSA[AHI (apnea hypopnea index)&lt;5], mild OSA[15&gt;AHI³5], moderate OSA[30&gt;AHI³15], severe OSA[AHI&gt;30]) and total sleep time(TST) using Cohen’s Kappa(K) for categorical and Bland-Altman plots for continuous variables. To further characterize PSG versus WP, the cohort was stratified into paroxysmal versus persistent AF types. 1A/1B hypopnea scoring criteria was defined as per AASM.

Results

Our cohort included 24 patients with AF(80% male, mean age 68y). Most patients had clinically defined OSA(AHI³5). Patients with persistent AF had more severe OSA than those with paroxysmal AF (severe OSA present in 60% vs. 29%). Comparison of PSG to concurrently conducted WP in the lab showed substantial agreement in OSA severity by both 1A(K=0.623) and 1B(0.706) criteria. Percent difference in TST between PSG versus WP in the paroxysmal AF versus persistent groups was not statistically significant(p=0.387). Comparing two consecutive at-home WP tests showed substantial agreement in OSA severity measures(1A=0.872,1B=0.889). Bland-Altman plots for TST and sleep architecture showed ³95% of residuals within 2 standard-deviations, suggesting intertester agreement. Confidence intervals were broad in these plots reflecting our small sample size.

Conclusion

Our findings demonstrate that WP is a reasonable alternative to PSG, particularly if using the 1B criteria to diagnose OSA. Additionally, our results show that persistent versus paroxysmal AF does not seem to affect the results of WP tests. Night to night variability of OSA measures and TST was small. Future studies should verify the results of our study in a larger cohort.

Support (If Any)

 

Dietary Patterns and Risk of a New Carious Lesion Postpartum: A Cohort Study

Dental caries (cavities), one of the most common infectious diseases, is caused by a number of factors. Oral microbes, dietary practices, sociodemographic factors, and dental hygiene all inform caries risk. Assessing the impact of diet is complicated as individuals eat foods in combinations, and the interactions among the foods may alter caries risk. Our study aimed to prospectively assess the association between dietary patterns and caries risk in the postpartum period, a potentially sensitive period for caries development. We analyzed in-person dental assessments and telephone food frequency questionnaires (FFQs) from 879 Caucasian women participating in the Center for Oral Health Research in Appalachia Cohort 2 (COHRA2) that were collected biannually for up to 6 y. One-week recall of food intake frequency was assessed using a Likert scale. We used principal component analysis to summarize the FFQ data; the top 2 components described 15% and 12% of the variance in FFQ data. The first component was characterized by high consumption of fruits and vegetables, while the second component was heavily influenced by desserts and crackers. We used a modified Poisson model to predict the risk of an increase in the number of decayed, missing, and filled teeth in the postpartum period by 1) dietary patterns and 2) individual foods and beverages at the previous study visit, after controlling for other known risk factors, including history of carious lesions. Eating a dietary pattern high in desserts and crackers was associated with a 20% increase in the number of decayed, missing, and filled teeth in the postpartum period (95% confidence interval, 1.03-1.39). However, this effect was attenuated among those who also consumed a dietary pattern high in fruits and vegetables. Dietary patterns should be considered when devising interventions aimed at preventing dental caries.

Lessons Learned From Clinical Recruitment of Older Adults With MCI for an Internet-Delivered Intervention Study

Clinical research involving participants with mild cognitive impairment (MCI) presents challenges to recruitment that may be further compounded by concerns when delivering a behavioral intervention via the Internet. The purpose of this talk is to describe recruitment adaptations for an Internet-delivered behavioral intervention study with older adults living with MCI and insomnia. Over the course of study recruitment, unforeseen barriers to recruitment were discovered, including fewer older adults with MCI endorsing sleep concerns than expected. The most substantive changes made to improve clinical recruitment were related to eligibility criteria, yielding 50% of the overall sample. Anticipated concerns of older adults with MCI using technology or accessing the Internet were not significant barriers to recruitment. Study findings support Internet-delivered intervention use in this population, which in the context of the COVID-19 pandemic, presents a potentially efficient and effective method for recruiting and delivering behavioral interventions in this difficult-to-enroll population.

Genomes for Kids: The scope of pathogenic mutations in pediatric cancer revealed by comprehensive DNA and RNA sequencing

Genomic studies of pediatric cancer have primarily focused on specific tumor types or high-risk disease. Here, we used a three-platform sequencing approach, including whole genome (WGS), exome, and RNA sequencing, to examine tumor and germline genomes from 309 prospectively identified children with newly diagnosed (85%) or relapsed/refractory (15%) cancers, unselected for tumor type. Eighty-six percent of patients harbored diagnostic (53%), prognostic (57%), therapeutically-relevant (25%), and/or cancer predisposing (18%) variants. Inclusion of WGS enabled detection of activating gene fusions and enhancer hijacks (36% and 8% of tumors, respectively), small intragenic deletions (15% of tumors) and mutational signatures revealing of pathogenic variant effects. Evaluation of paired tumor-normal data revealed relevance to tumor development for 55% of pathogenic germline variants. This study demonstrates the power of a three-platform approach that incorporates WGS to interrogate and interpret the full range of genomic variants across newly diagnosed as well as relapsed/refractory pediatric cancers.

Use of Technology in an Internet-Delivered Intervention for Older Adults With Mild Cognitive Impairment

Internet-based interventions using technology can promote access to treatment and reduce participant burden for sleep disorders. However, preliminary studies examining technology use and compliance in older adults with mild cognitive impairment (MCI) are needed prior to undertaking large-scale interventions. Older adults with MCI were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm intervention pilot study. An Internet-delivered cognitive behavioral therapy for insomnia program collected daily sleep diary data and delivered the automated intervention over nine weeks. Sleep diaries and wrist-worn actigraphs collected sleep data for 14 days, pre- and post-intervention. Descriptive statistics for participant technology use are presented. We have recruited 12 subjects with MCI. Most subjects with MCI accessed the intervention program daily; however, actiwatch compliance varied. Incorporating technology for intervention delivery and data collection in this population is promising, and future work should consider using reminders with wearable technology to increase compliance.

Multi-modal pain control regimen for anterior lumbar fusion drastically reduces in-hospital opioid consumption

Background

The opioid epidemic is at epic proportions currently in the United States. Exposure to opioids for surgery and subsequent postoperative pain management is a known risk factor for opioid dependence. In addition, opioids can have a negative impact on multiple aspects including clinical outcomes, length of hospital stay, and overall cost of care. Thus, the greatest effort to reduce perioperative opioid use is necessary and a multimodal pain control (MMPC) has been gaining popularity. However, its efficacy in spine surgery is not well known. We aimed to evaluate the efficacy of a MMPC protocol in patients undergoing lumbar single-level anterior lumbar interbody fusion (ALIF).

Methods

This is a retrospective comparative study. From a prospective, single-surgeon, surgical database, consecutive patients undergoing single-level ALIF with or without subsequent posterior fusion for degenerative lumbar conditions were identified before and after initiation of the MMPC protocol. The MMPC protocol consisted of a preoperative oral regimen of cyclobenzaprine (10 mg), gabapentin (600 mg), acetaminophen (1 g), and methadone (10 mg). Postoperatively they received a bilateral transverse abdominis plane block with 0.5% Ropivacaine prior to extubation. We compared in-hospital opioid consumption between the MMPC and non-MMPC cohorts as well as baseline demographic, the length of hospital stay, cost, and rate of postoperative ileus. Opioid consumption was calculated and normalized to the morphine milligram equivalents (MMEs).

Results

In total, 68 patients in the MMPC cohort and 39 in the non-MMPC cohort were identified. There was no difference in baseline demographics including sex, body mass index, smoking status, or preoperative opioid use between the two groups. Although there was no difference in the MMEs on the day of surgery (58.5 vs. 66.9, P=0.387), cumulative MMEs each day after surgery was significantly lower in the MMPC cohort, with final cumulative MMEs being reduced by 62% (120.2 vs. 314.8, P<0.001). There was no difference in postoperative ileus, length of stay, and hospital costs.

Conclusions

The use of a MMPC protocol in patients undergoing single-level ALIF for degenerative conditions reduced opioid consumption starting on the first day after surgery, resulting in a cumulative reduction of 62%.

E-cigarette constituents propylene glycol and vegetable glycerin decrease glucose uptake and its metabolism in airway epithelial cells in vitro

Electronic nicotine delivery systems, or e-cigarettes, utilize a liquid solution that normally contains propylene glycol (PG) and vegetable glycerin (VG) to generate vapor and act as a carrier for nicotine and flavorings. Evidence indicated these "carriers" reduced growth and survival of epithelial cells including those of the airway. We hypothesized that 3% PG or PG mixed with VG (3% PG/VG, 55:45) inhibited glucose uptake in human airway epithelial cells as a first step to reducing airway cell survival. Exposure of H441 or human bronchiolar epithelial cells (HBECs) to PG and PG/VG (30-60 min) inhibited glucose uptake and mitochondrial ATP synthesis. PG/VG inhibited glycolysis. PG/VG and mannitol reduced cell volume and height of air-liquid interface cultures. Mannitol, but not PG/VG, increased phosphorylation of p38 MAPK. PG/VG reduced transepithelial electrical resistance, which was associated with increased transepithelial solute permeability. PG/VG decreased fluorescence recovery after photobleaching of green fluorescent protein-linked glucose transporters GLUT1 and GLUT10, indicating that glucose transport function was compromised. Puffing PG/VG vapor onto the apical surface of primary HBECs for 10 min to mimic the effect of e-cigarette smoking also reduced glucose transport. In conclusion, short-term exposure to PG/VG, key components of e-cigarettes, decreased glucose transport and metabolism in airway cells. We propose that this was a result of PG/VG reduced cell volume and membrane fluidity, with further consequences on epithelial barrier function. Taking these results together, we suggest these factors contribute to reduced defensive properties of the epithelium. We propose that repeated/chronic exposure to these agents are likely to contribute to airway damage in e-cigarette users.

Real-world evidence for U.S. Food and Drug Administration-approved oncology products, 2015 to 2020

280

Background: Since the 21st Century Cures Act, there has been growing interest in using real-world evidence (RWE) to support regulatory filings for new drugs and indications. The goal of this study was to provide a comprehensive source of RWE use cases of U.S. Food and Drug Administration (FDA) approvals for oncology products. Methods: A systematic review of FDA new drug applications (NDAs) and biologics license applications (BLAs) from 1/2015-2/2020 for approved oncology products was performed. Data on the RWE study were extracted (data source, study design, statistical methods, results), and corresponding FDA comments were synthesized to identify patterns of the FDA’s review. Results: We identified 102 NDAs and BLAs, 8 (8%) of which included RWE, all post-Cures Act (see Table). RWE supporting avelumab, axicabtagene ciloleucel, and avapritinib were received positively and used by the FDA in their approval decision. RWE results were used to provide contextualization to the pivotal trial, rather than statistical comparison. Common data sources included Flatiron (38%) and chart reviews (38%). FDA critiques included lack of a priori study protocol, incomparability with the pivotal trial population and endpoints, and uncontrolled confounding. Conclusions: There have been few examples of RWE in oncology submissions, and most served to complement clinical trial results. To meet FDA standards, RWE studies should be clearly designed and discussed with the FDA and include robust methods to minimize bias. [Table: see text]

Guidelines for Cord Blood Unit Selection

Optimal cord blood (CB) unit selection is critical to maximize the likelihood of successful engraftment and survival after CB transplantation (CBT). However, unit selection can be complex because multiple characteristics must be considered including unit cell dose, donor-recipient human leukocyte antigen (HLA) match, and unit quality. This review provides evidence-based and experience-based comprehensive guidelines for CB unit selection. Topics addressed include the use of both the TNC and the CD34⁺ cell dose, as well as the CD34⁺ cell to TNC content ratio to evaluate unit progenitor cell content and engraftment potential, the acceptable TNC and CD34⁺ cell dose criteria that define an adequate single-unit graft, and the indication and acceptable cell dose criteria for double-unit grafts. The acceptable criteria for 6-loci (HLA-A, -B antigen, -DRB1 allele) and 8-allele (HLA-A, -B, -C, -DRB1) donor-recipient HLA match, the evaluation of patients with donor-specific HLA antibodies, and the multiple determinants of unit quality are also reviewed in detail. Finally, a practical step-by-step guide to CB searches and the principles that guide ultimate graft selection are outlined.

Survey of Serum Amyloid A and Bacterial and Viral Frequency Using qPCR Levels in Recently Captured Feral Donkeys from Death Valley National Park (California)

Feral donkey removal from state land has raised concerns in terms of disease transmission between equine species. Disease outbreaks may occur as a result of the relocation of animals to new environments. Virus and bacteria DNA load and serum amyloid A derived from the pathogenic processes that they involve were measured in recently captured donkeys. Blood and nasal swabs were collected from 85 donkeys (Death Valley National Park, Shoshone, California); 24 were retested after 30/60 days in the Scenic (Arizona) long-term holding facility co-mingled with feral donkeys from Arizona and Utah. Quantitative Real-Time PCR (qPCR) was performed to detect viral and bacterial genomic material (equine influenza A [EIV], equine rhinitis A and B viruses, AHV-2, AHV-3, AHV-5 and EHV-1, EHV-4, Streptococcus equi subspecies equi and zooepidemicus,). Significant relations between behavior, body condition score, nasal discharge, and coughing were found in donkeys for which AHV-2 and Streptococcus zooepidemicus DNA was detected. Higher SAA concentrations were found in foals. AHV-2 and Streptococcus zooepidemicus DNA concentrations significantly differed between sampling moments (p < 0.05). In conclusion, donkeys do not appear to be a substantial risk for disease transmission to horses but could be if they carried strangles or other processes in which AHV-2 and Streptococcus zooepidemicus were involved.

Abstract A57: Uncovering instrument errors in next-generation sequencing by CleanDeepSeq2

Liquid biopsy holds great promise in noninvasive diagnosis of cancers through detecting minute amounts of cell-free DNA released from cancer cells in non-solid biologic tissue such as peripheral blood. A critical bottleneck in developing liquid biopsy methods is the limited accuracy of current next-generation sequencing technology (NGS), evidenced by its high error rate (0.1%-1%, as of 2018). Through mathematical modeling of NGS errors, we have recently published a method to computationally suppress the current NGS error rate to between 10−5 and 10−4, two orders of magnitude lower than general reports. However, this error rate is a product of both PCR errors and instrument (i.e., sequencer) errors, and it is currently unknown how to separate these error sources. In this work, we developed a novel computational algorithm to precisely measure the errors caused by sequencers. By using 12 publicly available datasets from 10 sequencing centers (in America, Europe, and Asia), we discovered highly reproducible patterns of sequencer errors, including: 1) the overall sequencer error rate is 10−5; 2) at the flow-cell level, error rates are elevated in the bottom surface; 3) almost all flow cells have a small fraction of random tiles with a dramatically elevated error rate; 4) the elevated error rates appear to be enriched in some reaction cycles; 5) removal of these reaction cycles yields 5-fold lower error rates at some genomic loci, so that A&gt;C, A&gt;T, and C&gt;G error types have error rates close to 10−6; and 6) sequencer errors have a pattern markedly distinct from PCR errors. We have implemented the above observations into a general-purpose algorithm, termed CleanDeepSeq2, to computationally suppress sequencer errors and to also effectively monitor sequencer anomalies. CleanDeepSeq2 was engineered for efficiency so that a dataset with ultra-deep sequencing (1,000,000X depth) can be processed in 1.5N minutes on a single CPU core, where N is the number of target regions. Similarly, WES (100X) and WGS (~30X) datasets can be processed in under 1 CPU hour in order to monitor instrument performance. Overall, we have developed a computational method that for the first time enabled precise measurement of sequencer errors. Our study revealed novel insights on sequencer errors that can lead to improved instrumentation, NGS chemistry, and ultimately higher DNA sequencing fidelity. In addition, our developed software can efficiently suppress sequencer errors in addition to previously discovered error sources.

Citation Format: Eric Davis, Rain Sun, Ying Shao, Yanling Liu, Heather L. Mulder, Stephen V. Rice, John Easton, Jinghui Zhang, Xiaotu Ma. Uncovering instrument errors in next-generation sequencing by CleanDeepSeq2 [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr A57.

CICERO: a versatile method for detecting complex and diverse driver fusions using cancer RNA sequencing data

To discover driver fusions beyond canonical exon-to-exon chimeric transcripts, we develop CICERO, a local assembly-based algorithm that integrates RNA-seq read support with extensive annotation for candidate ranking. CICERO outperforms commonly used methods, achieving a 95% detection rate for 184 independently validated driver fusions including internal tandem duplications and other non-canonical events in 170 pediatric cancer transcriptomes. Re-analysis of TCGA glioblastoma RNA-seq unveils previously unreported kinase fusions (KLHL7-BRAF) and a 13% prevalence of EGFR C-terminal truncation. Accessible via standard or cloud-based implementation, CICERO enhances driver fusion detection for research and precision oncology. The CICERO source code is available at https://github.com/stjude/Cicero.

0622 In-Depth Surveillance of Central Sleep Apnea in Patients with Stable Heart Failure

Introduction

Central sleep apnea (CSA) is unique sleep breathing phenotype in patients with advanced chronic heart failure (HF) and portend poor prognosis. The prevalence of CSA in HF patients under contemporary therapy is uncertain.

Methods

We reviewed consecutive HF patients on optimal medical therapy who underwent clinically indicated diagnostic in-lab polysomnography at a single academic center. Age, sex and BMI matched patients without HF were selected from sleep clinic as a control. Patients with atrial fibrillation were excluded from this study. Apnea subtypes were determined after careful scoring and confirmation by sleep physicians. ‘Any CSA’ was defined by central apnea index (CAI) &gt;5 and &gt;1/hr. ‘True CSA’ was defined if met both CAI≥5/hr and &gt; obstructive apnea index (OAI). Obstructive sleep apnea (OSA) was defined if apnea hypopnea index &gt;15 and OAI&gt;CAI. Multivariate analysis was performed using logistic regression adjusting for age, sex, HF and systolic dysfunction as appropriate.

Results

In patients with HF (N=95, mean age 59, female: 50%), CSA was low and was comparable to control group (N=94) (HF vs. Non-HF; CSA: 5.3 vs. 4.3%, P=NS; Any CSA 14.7 vs. 17%, P=NS). Only 3 patients with HF had true CSA. In contrast, OSA was common in both groups regardless of obesity status (52.3 vs. 55.3%). In patients with HF, Cheyne Stokes respiration was more frequent in patients with Any CSA vs. without Any CSA (13.3 vs. 3.8%, p=0.04). In multivariate analysis, presence of OSA, but not HF, was associated with Any CSA in entire cohort (Any CSA OR: 3.1 [1.3, 8.1], p=0.02). In patients with HF, male sex was associated with Any CSA (OR: 5.3 [1.1, 40.8], p=0.05). Exclusion of patients with high BMI did not change the results.

Conclusion

CSA was rare in patients with stable HF on contemporary optimal medical therapy.

Support

None

Role of real-world evidence for oncology product registration in the United States: A review of approvals by the U.S. Food and Drug Administration from 2015 to 2019

e14130

Background: There are few concrete examples of real world evidence (RWE) used to support clinical development in regulatory filings despite growing interest in this field. This study systematically reviewed FDA oncology approvals to identify use cases of RWE. Methods: FDA’s new drug application (NDA) and biologics license application (BLA) approvals for oncology products from 2015-2019 were systematically reviewed. Among cases with RWE, data characterizing the submission and RWE details (data source, study design, FDA comments) were synthesized. Results: 93 approved NDAs and BLAs were identified; 6 included RWE in support of efficacy (see Table), approved on or after 2017, and were largely retrospective studies that contextualized results to pivotal trial, with primary endpoints overall survival (OS), overall response rate (ORR), and time to treatment discontinuation (TTD). Flatiron data were used in 3 of these as database analyses, 1 was an expanded access program (EAP), 1 was a meta-analysis, and 1 was a retrospective chart review. Conclusions: In the past 5 years, few FDA decisions incorporated RWE in oncology drug approvals. When used, RWE has been a complement rather than a supplement for clinical trial data. Early engagement, a priori protocol development, and robust research design (adjusting for bias, comparability to clinical trial population) remain key determinants for successful use of RWE in FDA decision making. [Table: see text]

Adherence to heart failure management medications following cardiac resynchronization therapy

Objective: The purpose of this study is to assess the real-world impact of cardiac resynchronization therapy (CRT) on adherence to heart failure (HF) medications.Methods: MarketScan administrative health care claims data from 2008 to 2014 among patients with HF were used. The date of first CRT implantation served as the index date. Adherence to guideline-directed medical therapy (GDMT) classes were compared during pre- and post-index periods using proportion of days covered (PDC). Comparisons between the two periods were made using the Wilcoxon sign-rank test for continuous PDC and McNemar's test for dichotomized PDC.Results: Increases in medication adherence were observed for major classes of HF GDMT medications. Specifically, adherence to angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), beta blockers (BB), and furosemide increased by 22, 24, 32, and 28% (all p < .001), respectively, in the 12 months pre to 12 months post-CRT. Large increases between the pre- and post-CRT period were also observed when considering adherence as dichotomized PDC ≥0.80 in the 12 months pre- versus post-CRT.Conclusion: Adherence to HF medications significantly improved among HF patients post-CRT implantation. Further research is needed to better understand the underlying determinants of this effect, including whether the effect is attributable to factors such as enhanced patient monitoring and improved access to high-quality specialized HF care among patients receiving CRT.

Evaluation of Cord Blood Total Nucleated and CD34+ Cell Content, Cell Dose, and 8-Allele HLA Match by Patient Ancestry

How cord blood (CB) CD34⁺ cell content and dose and 8-allele HLA match vary by patient ancestry is unknown. We analyzed cell content, dose, and high-resolution HLA-match of units selected for CB transplantation (CBT) by recipient ancestry. Of 544 units (286 infused, 258 next-best backups) chosen for 144 racially diverse adult patients (median weight, 81 kg), the median total nucleated cell (TNC) and CD34⁺cell ⁺contents were higher for Europeans than for non-Europeans: 216 × 10⁷versus 197 × 10⁷ (P = .002) and 160 × 10⁵ versus 132 × 10⁵ (P = .007), respectively. There were marked cell content disparities among ancestry groups, with units selected for Africans having the lowest TNC (189 × 10⁷) and CD34⁺ cell (122 × 10⁵) contents. Units for non-Europeans were also more HLA-mismatched (P = .017). When only the 286 transplanted units were analyzed, the adverse effect of reduced cell content was exacerbated by the higher weights in some groups. For example, northwestern Europeans (high patient weight, high unit cell content) had the best-dosed units, and Africans (high weight, low unit cell content) had the lowest. In Asians, low cell content was partially compensated for by lower weight. Marked differences in 8-allele HLA-match distribution were also observed by ancestry group; for example, 23% of units for northwestern Europeans were 3/8 to 4/8 HLA-matched, compared with 40% for southern Europeans, 46% for white Hispanics, and 51% for Africans. During the study period, 20 additional patients (17 non-Europeans; median weight, 98 kg) did not undergo CBT owing to the lack of a suitable graft. CB extends transplantation access to most patients, but racial disparities exist in cell content, dose, and HLA match.

Donkey and Mule Welfare

Donkeys and mules have been critical to the development of human civilization, since being domesticated some 6000 years ago. However, they suffer from being undervalued or ignored by development agencies and animal protection nongovernmental organizations. Where they are recognized as affecting agriculture and the economy it is often because they are seen as being either invasive pests or an anachronism in the developing countries of the twenty-first century. Even in the wealthier societies of the world, donkeys suffer from ignorance about their proper management or a booming industry in health care products based on donkey skin gelatin and milk byproducts.

Dedifferentiation in SDH-Deficient Gastrointestinal Stromal Tumor: A Report With Histologic, Immunophenotypic, and Molecular Characterization

One-third of gastrointestinal stromal tumors (GISTs) that lack KIT or PDGFRA mutations show succinate dehydrogenase (SDH) mutations or promoter hypermethylation. Most SDH-deficient GISTs occur in the pediatric, adolescent, or young adult setting and have unique features including predilection for the stomach, multinodular plexiform architecture, epithelioid cytology, prominence of lymphovascular invasion, and predilection for nodal metastasis. Dedifferentiation in GIST is a rare histologic change which may occur de novo or secondary to imatinib therapy and is characterized by abrupt transition of well-differentiated (WD) GIST to a subclonal anaplastic process that shows loss of immunohistochemical marks (CD117, DOG1). We describe the case of a previously healthy 18-year-old man who presented with a large gastric wall mass that contained 2 distinct morphologic populations. The first was WD and characterized by sweeping fascicles of bland spindled cells. This population abruptly transitioned to dedifferentiated (DD) foci composed of large sheets of discohesive cells that displayed a spectrum of rhabdoid and epithelioid morphologies with marked pleomorphism and mitotic activity. Immunohistochemically, the tumor showed variable staining in the 2 components with diffuse DOG-1 and CD117 positivity in the WD component and complete absence in the DD foci. SDH-B staining was lost in both components. Whole exome and transcriptome analysis was performed on tissue from both components and both showed an SDHB mutation (c.286G>A) as well as unique mutational burden and copy number profiles. Herein, we describe the first case of a DD SDH-deficient GIST with morphologic, immunophenotypic, and molecular characterization.

Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database

AIMS

To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus.

METHODS

A cross-sectional analysis of the lipid profile of children aged ≤ 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol ≥2.6 mmol/l or non-HDL cholesterol ≥3.1 mmol/l. LDL and non-HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA_1c and BMI-standard deviation score group, region, and common interactions between age, sex, HbA_1c and BMI.

RESULTS

This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA_1c and BMI. LDL and non-HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37-2.41), P<0.001; non-HDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78-2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol ≥2.6 mmol/l [0.89 (95% CI 0.82-0.97)] and non-HDL cholesterol ≥3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments.

CONCLUSIONS

Our results indicate that pump therapy is associated with a better lipid profile.

Quantifying the dark data in museum fossil collections as palaeontology undergoes a second digital revolution

Large-scale analysis of the fossil record requires aggregation of palaeontological data from individual fossil localities. Prior to computers, these synoptic datasets were compiled by hand, a laborious undertaking that took years of effort and forced palaeontologists to make difficult choices about what types of data to tabulate. The advent of desktop computers ushered in palaeontology's first digital revolution-online literature-based databases, such as the Paleobiology Database (PBDB). However, the published literature represents only a small proportion of the palaeontological data housed in museum collections. Although this issue has long been appreciated, the magnitude, and thus potential significance, of these so-called 'dark data' has been difficult to determine. Here, in the early phases of a second digital revolution in palaeontology--the digitization of museum collections-we provide an estimate of the magnitude of palaeontology's dark data. Digitization of our nine institutions' holdings of Cenozoic marine invertebrate collections from California, Oregon and Washington in the USA reveals that they represent 23 times the number of unique localities than are currently available in the PBDB. These data, and the vast quantity of similarly untapped dark data in other museum collections, will, when digitally mobilized, enhance palaeontologists' ability to make inferences about the patterns and processes of past evolutionary and ecological changes.

Somatic evolution and global expansion of an ancient transmissible cancer lineage

The canine transmissible venereal tumor (CTVT) is a cancer lineage that arose several millennia ago and survives by "metastasizing" between hosts through cell transfer. The somatic mutations in this cancer record its phylogeography and evolutionary history. We constructed a time-resolved phylogeny from 546 CTVT exomes and describe the lineage's worldwide expansion. Examining variation in mutational exposure, we identify a highly context-specific mutational process that operated early in the cancer's evolution but subsequently vanished, correlate ultraviolet-light mutagenesis with tumor latitude, and describe tumors with heritable hyperactivity of an endogenous mutational process. CTVT displays little evidence of ongoing positive selection, and negative selection is detectable only in essential genes. We illustrate how long-lived clonal organisms capture changing mutagenic environments, and reveal that neutral genetic drift is the dominant feature of long-term cancer evolution.

Comprehensive Report of the Caseload of Donkeys and Mules Presented to a Veterinary Medical Teaching Hospital over a Ten-Year Period

Simple Summary

We sought to provide a comprehensive report of the caseload of donkeys and mules at the Veterinary Medical Teaching Hospital at the University of California, Davis for a ten-year period. The caseload of donkeys and mules was 1.06% of the total equid caseload and was comprised of animals that received a good standard of veterinary care, including both routine wellness and medical care. Most animals tended to be older, around 10 years of age, and possessed high body condition scores. Obesity was reported, especially in donkeys. Most mules were used for riding, packing or driving, and most donkeys were in sanctuary and rescue farms. We report in detail the preventative health and veterinary medical care of these donkeys and mules. Our findings provide a greater understanding of the health and welfare of donkeys and mules residing in the western United States.

Abstract

Comprehensive reports of the caseload of donkeys and mules in veterinary hospitals in the United States are lacking. We compiled the information of the caseload of donkeys and mules at the Veterinary Medical Teaching Hospital at the University of California, Davis for a ten-year period, from 2008 to 2017. The overall equid caseload was 94,147, of which 996 (1.06%) were donkeys and mules. Most of the neonates seen were mules. Most miniature donkeys were between 2 and 10 years of age, and standard donkeys and mules were 10 to 20 years old. The body condition scores were predominantly high, especially in donkeys. Most miniature and standard donkeys resided in sanctuary and rescue farms and their use was not stated. Most mules were used for riding, packing or driving. Medical complaints represented 62% of the total visits and wellness visits represented 38% of total visits. The donkeys and mules in the case population described here received a good standard of veterinary care with regular vaccinations, deworming, routine dental care, and treatment of ailments. Our study is the first report of the life expectancy, use, body condition, preventative health and veterinary medical care of a population of donkeys and mules in the western United States.