The Challenges of Vaccine Trial Participation among Underserved and Hard-to-Reach Communities: An Internal Expert Consultation of the VACCELERATE Consortium

Underserved and hard-to-reach population groups are under-represented in vaccine trials. Thus, we aimed to identify the challenges of vaccine trial participation of these groups in member countries of the VACCELERATE network. Seventeen National Coordinators (NC), each representing their respective country (15 European countries, Israel, and Turkey), completed an online survey. From 15 eligible groups, those that were more frequently declared underserved/hard-to-reach in vaccine research were ethnic minorities (76.5%), persons experiencing homelessness (70.6%), illegal workers and refugees (64.7%, each). When prioritization for education on vaccine trials was considered, ethnic groups, migrants, and immigrants (5/17, 29.4%) were the groups most frequently identified by the NC as top targets. The most prominent barriers in vaccine trial participation affecting all groups were low levels of health literacy, reluctance to participate in trials due to engagement level, and low levels of trust in vaccines/vaccinations. This study highlighted population groups considered underserved/hard-to-reach in countries contained within the European region, and the respective barriers these groups face when participating in clinical studies. Our findings aid with the design of tailored interventions (within-and across-countries of the European region) and with the development of strategies to overcome major barriers in phase 2 and phase 3 vaccine trial participation.

Enhancing public health communication of vaccine trials: The pan-European VACCELERATE Toolkit

BACKGROUND

The pan-European VACCELERATE network aims to implement the first transnational harmonised and sustainable vaccine trial Volunteer Registry, serving as single entry-point for volunteers willing to participate in large scale vaccine clinical studies across the European region. The present work exhibits a set of harmonised vaccine trial educational and promotional tools for the general public, designed and disseminated by the pan-European VACCELERATE network.

OBJECTIVE

The main objectives of the present study are the design and creation of a standard toolkit to increase positive attitudes, and access to trustful information for better access and increased recruitment to vaccine trials for the public community. More specifically, the produced tools are focused on inclusiveness, equity, and they are targeting different population groups, including underserved ones, as potential volunteers for the VACCELERATE Volunteer Registry (elderly, migrants, children and adolescents). The promotion/education material is aligned with the main objectives of the Volunteer Registry, to increase public literacy and awareness regarding vaccine clinical research/trials and trial participation, such as informed consent and legal issues, side effects and frequently asked questions on vaccine trial design.

METHODS

The tools' development has followed the aims and principles of the VACCELERATE project, focusing on trial inclusiveness and equity and they are adjusted to the local country requirements to improve public health communication. The selection of the produced tools has been based on the cognitive theory, inclusiveness and equity of different aged and under-represented groups, and standardised material from several official trustful sources (e.g. COVAX, ECDC, EUPATI, GAVI and WHO). In addition, team of specialists from different fields (infectious diseases, vaccine research, medicine, education) edited and reviewed the subtitles and scripts for the educational videos, extended brochures, interactive cards and puzzles. Graph designers also selected the colour palette, audio settings and dubbing for the video story-tales and implementation of QR codes.

RESULTS

This study presents the first set of harmonised promotional and educational materials/tools (i.e. educational cards, educational and promotional videos, extended brochures, flyers, posters, and puzzles) for vaccine clinical research (e.g. COVID-19). The developed tools inform the public about possible benefits and disadvantages of trial participation, but also build the confidence of participants about the safety and efficacy for COVID-19 vaccines and healthcare system. The present material has been translated into several languages and meant to be freely and easily accessible to facilitate dissemination among the participating countries of the VACCELERATE network, as well as among the European and global scientific, industrial, and public community, in general.

CONCLUSIONS

The produced material could also be useful for filling knowledge gaps of healthcare personnel and providing the appropriate future patient education for vaccine trials, as well as to tackle vaccine hesitancy and parents' concerns for potential participation of children in vaccine trials.

POS1154 OUTCOMES AND RESOURCE UTILIZATION AFTER TOTAL HIP ARTHROPLASTY IN PATIENTS WITH CALCIUM PYROPHOSPHATE DEPOSITION DISEASE

Background

Total hip arthroplasty (THA) is a safe and effective treatment option in patients with advanced degenerative joint disease who have failed conservative management. Calcium pyrophosphate deposition disease (CPPD) is a common crystal-induced arthritis in older adults characterized by the deposition of calcium pyrophosphate crystals in the articular and periarticular tissues1. CPPD might manifested with acute and chronic arthritis that can lead to joint damage and the need for joint replacement. To our knowledge, no previous studies investigated the outcomes of CPPD patients who underwent THA.

Objectives

We aim to examine the mortality, in-hospital complications, and resource utilization following THA in patients with and without CPPD.

Methods

We queried the US National Inpatient Sample (NIS) database to identify patients who underwent THA between 2006 and 2014. The ICD-9 code 81.51 was used to identify the patients who underwent THA and of those, we classified 2 groups of patients: (i) those with ICD-9 codes defining CPPD (275.49 and 712.1–712.39) and (ii) those without any CPPD code. Data collection included patient demographics and comorbidities. Outcomes post-THA were in-hospital mortality, hospital length of stay, hospital charges, and discharge disposition. Associations between CPPD and specific morbidity were evaluated with chi-square tests. T tests were used for continuous variables.

Results

Among the 4,111,808 (adjusted for sampling weight) patients who underwent THA between 2006 and 2014, 6198 (0.15%) had CPPD, with a mean age of 77 years and 65.2% were females (Table 1). CPPD patients were more likely to be older (mean age 77 vs 72.7; p<0.001) than non-CPPD patients. Comorbidities more frequently observed among CPPD patients included chronic kidney disease, osteoarthritis, rheumatoid arthritis, gout, hyperparathyroidism and hypomagnesemia. Further, Charlson Comorbidity Index scores ≥ 2 was more frequent seen in CPPD (96.1% vs 89.1%, p <0.001). The in-hospital mortality post-THA was lower in the CPPD patients (0.76% vs 1.72%, p <0.001). THA in CPPD patients was associated with a longer mean length of stay than those without CPPD (6 vs 5.1 days; p <0.001) while mean total charges were not statistically different between the 2 groups (p=0.344). CPPD patients were more likely to be discharged to rehabilitation or other nursing facilities (p<0.001).

Table 1.

Demographics, clinical characteristics, outcomes and resource utilization of patients with and without CPPD who underwent hip arthroplasty between 2006-2014.

No CPDD, n (%) (N=4105610)CPPD, n (%) (N=6198)P-value*Age in years at admission, median (mean ± SD)75 (72.7 ± 31.5)80 (77.0 ± 24.2)<0.001†Female2507971 (61.1)3979 (64.2)<0.001Chronic kidney disease516688 (12.5)1154 (18.6)<0.001Osteoarthritis684171 (16.6)1280(20.6)< 0.001Gout139648 (3.4)330 (5.3)<0.001Rheumatoid arthritis199175 (4.8)478(7.7)<0.001Hyperparathyroidism7959 (0.1)24(0.3)<0.001Hypomagnesemia100390 (2.45)239 (3.86)<0.001Charlson Comorbidity Index score ≥ 23659906 (89.1)5961(96.1)<0.001Outcomes/Resource utilizationLength of stay, (mean ± SD)5.15 ± 11.726.04 ± 13.91<0.001†Total hospital charges, (mean ± SD)$ 41284 ± 108238($ 42757 ± 124894)0.344†Death during hospitalization70706 (1.7)47 (0.7)<0.001†Discharge DispositionHome (including home health care)2653860 (64.7)3558 (57.4)<0.001All others§1447312 (35.3)2635 (42.5)<0.001

*Chi-square P except †t-test

§All others include transfer to nursing or rehabilitation facility.

Conclusion

CPPD patients who underwent THA were more likely to be older, with a higher comorbidity burden, longer length of stay, and discharged to a non-home setting, than non-CPPD patients.

References

[1]Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016;d 374(26):2575-84.

Disclosure of Interests

None declared

AB1508 A NOVEL PATHOGENIC VARIANT IN ZNF462 GENE ASSOCIATED WITH WEISS-KRUSZKA SYNDROME AND SLE

Background

Weiss-Kruszka syndrome (WSKA) is an autosomal dominant congenital anomaly syndrome due to mutations in the ZNF462 gene and manifests with developmental delay and multiple craniofacial abnormalities with variable expressivity1. It is also characterized by cognitive impairment, whilst about a third of the affected individuals belong to the autism spectrum. Although the disease is inherited with the autosomal dominant manner, most of the described subjects (95%) had de novo variants with no affected family members1. WSKA has been recently described and only 26 (including our patient) affected individuals have been classified to date2. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by the presence of autoantibodies and multi-organ inflammation. Genetic factors might play an important role in disease pathogenesis in patients with childhood-onset SLE.

Objectives

To describe the case of a SLE patient who was found to have WSKA related to a novel pathogenic autosomal dominant (AD) variant in the ZNF462 gene, and inform clinicians of a possible association between the 2 conditions.

Methods

A 25-year-old Caucasian female with a history of SLE, diagnosed at the age of 14, manifested with malar rash, Raynaud’s phenomenon, arthritis, thrombocytopenia, positive ANA, ds-DNA antibody and hypocomplementemia. At the age of 17, she developed renal dysfunction due to lupus nephritis class IV, and she was treated with glucocorticoids (GCs), cyclophosphamide and hydroxychloroquine. In Oct 2020, she was admitted to the hospital for thrombotic thrombocytopenic purpura due to lupus exacerbation. She was successfully treated with GCs, plasma exchange and rituximab. During her hospitalization, the presence of various clinical features raised the suspicion of a genetic syndrome. First, the patient exhibited dysmorphic features such as hypertelorism, prognathism, arched eyebrows, flattened nasal bridge, small upper lip, mild intellectual disability, and a history of childhood-onset SLE. Whole exome sequencing (WES) by NGS was used for the genetic investigation of the patient.

Figure 1.

Results

The patient underwent genetic evaluation with WES and the novel heterozygous AD pathogenic variant c.4142delT (p.lle1381ThrfsTer16) in ZNF462 gene was identified. Confirmation of the identified variant was also verified by sanger sequencing. Pathogenic variants in the ZNF462 gene were previously described in patients with the recently reported WSKA of which several characteristics are compatible with our patient’s features. The ZFN462 encodes a zinc-finger transcription factor that plays a role in embryonic development, transcriptional regulation, and chromatin remodelling. Given that chromatin remodelling has been implicated in the pathogenesis of SLE, the association of this novel ZNF462 variant in the development of SLE, needs to be determined3.

Conclusion

This is the first report of a patient with coexisting SLE and WSKA due to a novel variant. It illustrates the need for further research in order to elucidate any possible pathophysiologic link among the 2 conditions.

References

[1]Weiss K, Wigby K, Fannemel M, Henderson LB, Beck N, Ghali N, Study DDD, Anderlid BM, Lundin J, Hamosh A, Jones MC, Ghedia S, Muenke M, Kruszka P. Haploinsufficiency of ZNF462 is associated with craniofacial anomalies, corpus callosum dysgenesis, ptosis, and developmental delay. Eur J Hum Genet. 2017 Aug;25(8):946-951. doi: 10.1038/ejhg.2017.86. Epub 2017 May 17. PMID: 28513610; PMCID: PMC5567153.

[2]Park J, Ha DJ, Seo GH, Maeng S, Kang SM, Kim S, Lee JE. Empty Sella Syndrome Associated with Growth Hormone Deficiency: the First Case Report of Weiss-Kruszka Syndrome. J Korean Med Sci. 2021 May 10;36(18):e133. doi: 10.3346/jkms.2021.36.e133. PMID: 33975400; PMCID: PMC8111047.

[3]Surace AEA, Hedrich CM. The Role of Epigenetics in Autoimmune/Inflammatory Disease. Front Immunol. 2019 Jul 4;10:1525. doi: 10.3389/fimmu.2019.01525. PMID: 31333659; PMCID: PMC6620790.

Disclosure of Interests

None declared

Measurement of the neutron charge radius and the role of its constituents

The neutron is a cornerstone in our depiction of the visible universe. Despite the neutron zero-net electric charge, the asymmetric distribution of the positively- (up) and negatively-charged (down) quarks, a result of the complex quark-gluon dynamics, lead to a negative value for its squared charge radius, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\langle {r}_{{\rm{n}}}^{2}\rangle$$\end{document}⟨rn2⟩. The precise measurement of the neutron’s charge radius thus emerges as an essential part of unraveling its structure. Here we report on a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\langle {r}_{{\rm{n}}}^{2}\rangle$$\end{document}⟨rn2⟩ measurement, based on the extraction of the neutron electric form factor, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${G}_{{\rm{E}}}^{{\rm{n}}}$$\end{document}GEn, at low four-momentum transfer squared (Q²) by exploiting the long known connection between the N → Δ quadrupole transitions and the neutron electric form factor. Our result, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\langle {r}_{{\rm{n}}}^{2}\rangle =-0.110\pm 0.008\,({{\rm{fm}}}^{2})$$\end{document}⟨rn2⟩=−0.110±0.008(fm2), addresses long standing unresolved discrepancies in the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\langle {r}_{{\rm{n}}}^{2}\rangle$$\end{document}⟨rn2⟩ determination. The dynamics of the strong nuclear force can be viewed through the precise picture of the neutron’s constituent distributions that result into the non-zero \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\langle {r}_{{\rm{n}}}^{2}\rangle$$\end{document}⟨rn2⟩ value.

The charge radius of nucleons provides information about their structure. Here the authors present a method, based values of neutron electric form factors, to determine the charge radius of the neutron and provide information on improving the uncertainty of neutron charge radius measurements

The effects of McConnell patellofemoral joint and tibial internal rotation limitation taping techniques in people with Patellofemoral pain syndrome

BACKGROUND

Taping is frequently used as part of the multi-modal management for patellofemoral pain syndrome (PFPS). McConnell Patellofemoral Joint Taping (PFJT) and Tibial Internal Rotation Limitation Taping (TIRLT) are proposed to be useful adjuncts to the management of PFPS. However, it is unclear if TIRLT offers similar benefits to PFJT, and its effect on pain and lower limb kinematics have not been investigated previously.

RESEARCH QUESTION

What are the effects of TIRLT, PFJT and no taping on perceived pain and lower limb kinematics during a lunge and single leg squat (SLS) in people with PFPS?

METHODS

This cross-sectional study compared the effects of TIRLT, PFJT and no taping, on knee pain and lower limb kinematics during two pain-provoking movements in people with PFPS. Participants with PFPS (n = 23) performed a lunge and SLS under three randomised conditions: TIRLT, PFJT and no taping. The Codamotion system captured and analysed lower limb kinematic data in the sagittal, transverse and coronal planes. Peak knee pain intensity during the movement was assessed using the Numerical Rating Scale (NRS).

RESULTS

Participants reported significantly less pain with the TIRLT and PFJT techniques compared with no tape during the lunge (p = 0.005 and p = 0.011, respectively) and SLS (p= 0.002 and p = 0.001, respectively). There was no evidence of altered lower limb kinematics accompanying pain reductions with either taping technique.

SIGNIFICANCE

Both forms of taping may be useful adjuncts as the short-term benefit of pain relief may enable participation in more active forms of rehabilitation.

Individuals with mild-to-moderate hip osteoarthritis walk with lower hip joint contact forces despite higher levels of muscle co-contraction compared to healthy individuals

OBJECTIVE

To compare hip joint contact forces (HJCF), hip muscle forces, and hip muscle co-contraction levels between individuals with mild-to-moderate hip osteoarthritis (OA) and healthy controls during walking.

DESIGN

Eighteen participants with mild-to-moderate hip OA and 23 healthy controls walked at a self-selected speed while motion capture and electromyographic data were synchronously collected. HJCF were computed using a calibrated electromyography-informed neuromusculoskeletal model. Hip joint contact forces, muscle forces, and co-contraction indices for flexor/extensor and adductor/abductor muscle groups were compared between groups using independent sample t-tests (P < 0.05).

RESULTS

There was no between-group difference in self-selected walking speed. On average, participants with hip OA walked with 11% lower first peak (mean difference 235 [95% confidence interval (CI) 57-413] N) and 22% lower second peak (mean difference 574 [95%CI 304-844] N) HJCF compared to controls. Hip muscle forces were also significantly lower in the hip OA compared to control group at first (mean difference 224 [95%CI 66-382] N) and second (mean difference 782 [95%CI 399-1164] N) peak HJCF. Participants with hip OA exhibited higher levels of hip muscle co-contraction in both flexor/extensor and adductor/abductor muscle groups. Consistent with existing literature, hip joint angles (extension, adduction) and external moments (flexion, extension, adduction) were lower in hip OA compared to controls.

CONCLUSION

Lower HJCF were detected in mild-to-moderate hip OA, primarily due to lower hip muscle force production, and despite higher levels of hip muscle co-contraction. Findings suggest that lower loading of the hip joint during walking is a feature of mild-to-moderate hip OA, which could have implications for the pathogenesis of hip OA and/or disease progression.

Nucleon Spin and Momentum Decomposition Using Lattice QCD Simulations

We determine within lattice QCD the nucleon spin carried by valence and sea quarks and gluons. The calculation is performed using an ensemble of gauge configurations with two degenerate light quarks with mass fixed to approximately reproduce the physical pion mass. We find that the total angular momentum carried by the quarks in the nucleon is J_{u+d+s}=0.408(61)_{stat}(48)_{syst} and the gluon contribution is J_{g}=0.133(11)_{stat}(14)_{syst}, giving a total of J_{N}=0.54(6)_{stat}(5)_{syst} that is consistent with the spin sum. For the quark intrinsic spin contribution, we obtain 1/2ΔΣ_{u+d+s}=0.201(17)_{stat}(5)_{syst}. All quantities are given in the modified minimal subtraction scheme at 2 GeV. The quark and gluon momentum fractions are also computed and add up to ⟨x⟩_{u+d+s}+⟨x⟩_{g}=0.804(121)_{stat}(95)_{syst}+0.267(12)_{stat}(10)_{syst}=1.07(12)_{stat}(10)_{syst}, thus satisfying the momentum sum.

Direct Evaluation of the Quark Content of Nucleons from Lattice QCD at the Physical Point

We evaluate the light, strange, and charm scalar content of the nucleon using one lattice QCD ensemble generated with two degenerate light quarks with mass fixed to their physical value. We use improved techniques to evaluate the disconnected quark loops to sufficient accuracy to determine the strange and charm nucleon σ terms in addition to the light quark content σ_{πN}. We find σ_{πN}=37.2(2.6)(4.7/2.9)  MeV, σ_{s}=41.1(8.2)(7.8/5.8)  MeV, and σ_{c}=79(21)(12/8)  MeV, where the first error is statistical and the second is the systematic error due to the determination of the lattice spacing, the assessment of finite volume, and residual excited state effects.

Another rare case of a child with de novo terminal 9p deletion and co-existing interstitial 9p duplication: clinical findings and molecular cytogenetic study by array-CGH

Trisomy 9p is the fourth most common chromosome abnormality found in liveborns. We report on a rare case of partial trisomy 9p complicated by partial monosomy 9p. Clinical manifestation included craniofacial abnormalities typical for trisomy 9p syndrome, developmental delay, mental retardation and brain anomaly in the form of Dandy-Walker malformation. The cytogenetic abnormality was investigated with FISH and array-CGH to characterize the breakpoints of the complex rearrangement. The patient's karyotype was 46,XX,der(9)del(9)(p24)dup(9)(p21p24)dn.arr 9p24.3p24.2 (1-2,414,485)×1,9p24.2p21.3(2,414,485-24,101,280)×3. The cytogenetic rearrangement led to a 2.4-Mb deletion of 9p24.2pter and a 21.6-Mb duplication of 9p24.2p21.3. The clinical and cytogenetic findings in our and other similar patients are compared.

Microbiological and clinical profiles of patients with microbial keratitis residing in nursing homes

AIM

To study the microbiological and clinical profile of patients with microbial keratitis living in nursing homes.

METHODS

A retrospective analysis of hospital records from 1996 to 2006 of patients who had microbial keratitis, and were living in nursing homes, was undertaken. The main parameters evaluated were clinical and microbiological profile and final visual outcome.

RESULTS

Of 66 patients included in this study, 39 were female and 27 were male, with mean age of 81(SD 11) (range 46-97) years. The major ocular and systemic factors associated with the occurrence of microbial keratitis were the presence of dry eyes (26%) and rheumatoid arthritis (81%), respectively. A positive bacterial culture was obtained in 54 (82%) cases with Staphylococcus being the most prevalent isolate (48%). Seven patients had positive culture for herpes virus. Surgical intervention had to be performed in 31(47%) of cases mainly in the form of botox injection for induction of ptosis (n = 9, 27%), keratoplasty (n = 8, 24%), tarsorrhaphy (n = 5, 15%) or glue (n = 3, 9%). The mean pre-treatment and post-treatment visual acuity was counting fingers and 6/60 respectively.

CONCLUSIONS

Microbial keratitis in patients living in nursing homes is usually caused by Staphylococcus and is associated with dry eyes and ocular surface disease. Surgical intervention is required in majority of cases with poor visual outcome.

Trisomy of medial 15q as result of an analphoid supernumerary ring chromosome detected by CGH and FISH

We report a 21-year-old patient with a de novo mosaic, analphoid ring of chromosome 15q22.2-->q24.1. The clinical features of this patient are mild and include tall stature, obesity, striae distensae in the hypogastrium, malocclusion and bilateral gynecomastia with scarce glandular tissue. M-FISH and FISH using a chromosome 15 painting probe indicated that the ring is of chromosome 15 origin. Further CGH analysis and FISH with the PML locus-specific probe demonstrated that the extra material derived from the medial part of the long arm of chromosome 15, including two bands, q22 and q23. Additionally, FISH with BAC probes specific for 15q allowed for a localization of the breakpoints at 15q22.2 and 15q24.1, distal to clones RP11-30M4 and RP11-500O23 respectively. We discuss the relationship between the patient's genotype and phenotype comparing it to reported cases of trisomy of medial 15q.

Monitoring tumor response to ZD4190 therapy with an 18F labeled angiogenesis imaging agent

10507

Background: While a number of novel therapies are being developed to inhibit the growth or survival of tumor vasculature, there are limited methods available for measuring changes in tumor vascularity. In order to quantify tumour vascularity by PET imaging, we examined an 18F-radiolabeled small peptide (AH111585) containing an RGD (Arg-Gly-Asp) sequence. This peptide binds with high affinity (nM) to avβ3 integrin, a cell adhesion receptor that is highly expressed on tumor neovasculature, but expressed at low levels on mature endothelium and epithelial cells. 18F-AH111585 was used to examine the response of human lung tumor xenografts to treatment with ZD4190, a small molecule inhibitor of VEGF signaling. Methods: MicroPET (using 18F-AH111585) and microCT imaging data was acquired pre and post 3 doses of ZD4190 (100 mg/kg, p.o., over 3 days) or vehicle in CD-1 nude mice bearing Calu-6 tumor xenografts. 18F-AH111585 was administered 2 h prior to microPET imaging (10 min) to allow for tumor uptake and background tissue clearance. Tumor and background tissue uptake was determined from the images (expressed as %id/g). Results: Uptake of 18F-AH111585 in Calu-6 tumors was reduced following 3 doses of ZD4190, with an average reduction of 31.8 ± 4.6 % (calculated from imaging ROI data), whereas increased 18F-AH111585 uptake was observed in tumors of vehicle treated mice (average increase of 26.9 ± 9.4 %). The difference between treated and control group uptake was statistically significant (P<0.01; two- tailed t-test). Tumor size (assessed via caliper measurement) remained comparable over the duration of treatment. Skeletal muscle, used as a reference tissue for ROI analysis, demonstrated equivalent uptake pre and post therapy. Conclusions: The data demonstrate that 18F-AH111585 can detect changes in tumor uptake following acute treatment with a VEGF signaling inhibitor (ZD4190). The results suggest that this imaging agent may be useful for monitoring changes in tumor vascularity.

No significant financial relationships to disclose.

Moraxella keratitis: predisposing factors and clinical review of 95 cases

AIM

To analyse the clinical presentation, identify predisposing risk factors and evaluate the outcome of treatment of Moraxella keratitis.

METHODS

A retrospective analysis was carried out of culture-proved cases of Moraxella keratitis from hospital records during a 10-year period (from December 1995 to November 2005) at the Corneal Unit of the Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

RESULTS

95 episodes of Moraxella keratitis were identified in 92 patients. 3 (3.2%) patients had recurrent keratitis. The mean age of the patients was 70 (range 17-93) years. Multiple predisposing factors were identified in 23 (24%) eyes, including corneal graft (n = 15), previous herpes keratitis (n = 15) and eye lid diseases (n = 15). Adjunctive procedures were carried out in 42 eyes. These included botulinum toxin injection (n = 17), tarsorraphy (n = 12), penetrating keratoplasty (n = 8), enucleation (n = 3), tissue adhesive and bandage contact lens (n = 4), and conjunctival flap (n = 5). Polymicrobial infection was present in 17 eyes. Final visual acuity was counting finger or less in 25 (26%) eyes.

CONCLUSIONS

Local ocular predisposing factors play a major role in Moraxella keratitis. This infection has a poor visual outcome attributable to both the nature of the infection and the predisposing factors.

Randomised controlled trial of topical ciclosporin A in steroid dependent allergic conjunctivitis

AIM

To evaluate the efficacy, safety, and therapeutic effect of topical ciclosporin A 0.05% as a steroid sparing agent in steroid dependent allergic conjunctivitis.

METHODS

Prospective, randomised, double masked, placebo controlled trial comparing signs, symptoms, and the ability to reduce or stop concurrent steroid in steroid dependent atopic keratoconjunctivitis and vernal keratoconjunctivitis using 0.05% topical ciclosporin A compared to placebo. Steroid drop usage per week (drug score), symptoms, and clinical signs scores were the main outcome measures.

RESULTS

The study included an enrolment of 40 patients, 18 with atopic keratoconjunctivitis and 22 with vernal keratoconjunctivitis. There was no statistical significant difference in drug score, symptoms, or clinical signs scores between the placebo and ciclosporin group at the end of the treatment period. No adverse reactions to any of the study formulations were encountered.

CONCLUSIONS

Topical ciclosporin A 0.05% was not shown to be of any benefit over placebo as a steroid sparing agent in steroid dependent allergic eye disease.

Richter syndrome first manifesting as cutaneous B-cell lymphoma clonally distinct from primary B-cell chronic lymphocytic leukaemia

Richter syndrome (RS) is a transformation to high-grade non-Hodgkin lymphoma in patients with chronic lymphocytic leukaemia (CLL). RS may develop in lymph nodes or rarely extranodally. Skin localization of RS has been described in only a few cases. We present a 77-year-old woman who developed isolated diffuse large B-cell lymphoma (LBCL) in the skin of the nose without any other symptoms of RS. The LBCL in the skin was clonally distinct from the original bone marrow CLL cells. Moreover, LBCL cells were positive for LMP-1 segment of Epstein-Barr virus and overexpressed p53 protein. The patient was successfully treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) and adjuvant local radiotherapy.

Genetic counseling in carriers of reciprocal chromosomal translocations involving long arm of chromosome 16

Families with balanced chromosomal changes ascertained by unbalanced progeny, miscarriages, or by chance are interested in their probability for unbalanced offspring and other unfavorable pregnancy outcomes. This is usually done based on the original data published by Stengel-Rutkowski et al. several decades ago. That data set has never been updated. It is particularly true for the subgroup with low number of observations, to which belong reciprocal chromosomal translocations (RCTs) with breakpoint in an interstitial segment of 16q. The 11 pedigrees from original data together with the new 18 pedigrees of RCT carriers at risk of single-segment imbalance detected among 100 pedigrees of RCT carriers with breakpoint position at 16q were used for re-evaluation of the probability estimation for unbalanced offspring at birth and at second trimester of prenatal diagnosis, published in 1988. The new probability rate for unbalanced offspring after 2 : 2 disjunction and adjacent-1 segregation for the total group of pedigrees was 4 +/- 3.9% (1/25). In addition, the probability estimate for unbalanced fetuses at second trimester of prenatal diagnosis was calculated as 2/11, i.e. 18.2 +/- 11.6%. The probability rates for miscarriages and stillbirths/early deaths were about 16 +/- 7.3% (4/25) and <2% (0/25), respectively. Considering different segment lengths of 16q, higher probability rate (0/8, i.e. <6.1%) for maternal RCT carriers at risk of distal 16q segment imbalance (shorter segment) was obtained in comparison with the rate (0/10, i.e. <4.8%) for RCT at risk of proximal segment imbalance (longer segment). It supports findings obtained from the original data for RCT with other chromosomes, where the probability for unbalanced offspring generally increased with decreasing length of the segments involved in RCT. Our results were applied for five new families with RCT involving 16q, namely three at risk of single-segment imbalance [t(8;16)(q24.3;q22)GTG, ish(wcp8+,wcp16+;wcp8-,wcp16+), t(11;16)(q25;q22)GTG, and t(11;16)(q25;q13)GTG] and two with RCT at risk of double-segment imbalance [t(16;19)(q13;q13.3)GTG, isht(16;19)(q13;q13.3) (D16Z3+,16QTEL013-D19S238E+,TEL19pR-; D16Z3-, D19S238E-,TEL19pR+), and t(16;20)(q11.1;q12)GTG, m ish,t(16;20)(wcp16+,wcp20+;wcp16+,wcp20+)]. They have been presented in details to illustrate how the available empiric data could be used in practice for genetic counseling.

Traumatic tear of tibialis anterior during a Gaelic football game: a case report

Reports of traumatic injury to the anterior lower leg muscles are scarce, with only a handful of reports of traumatic injury to the tibialis anterior. A database search of Medline, Cinhal, and Sports Discus only revealed three such cases, and they did not result from a direct sporting injury. This report documents the case of a traumatic rupture of tibialis anterior muscle in a young female Gaelic football player. It details the surgical repair and management of tibialis anterior muscle and the physiotherapy rehabilitation to full function.

Application of FISH and Q-PCR techniques in breakpoint diagnostics in three cases of marker chromosomes derived from chromosome 15

BACKGROUND

The goal of the study was a search for effective methods of diagnosing additional marker chromosomes.

MATERIAL AND METHODS

Three cases of extra structurally abnormal chromosomes (ESACs) were diagnosed, the ESACs having been derived from chromosome 15 by cytogenetic techniques, the fluorescence in situ hybridisation (FISH) technique and the quantitative--polymerase chain reaction (Q-PCR). An application of a set of commercially available probes, specific for the 15q11.2-q12 regions (PWACR-Prader-Willi/Angelman Critical Region) allowed for a description of the breaking points.

RESULTS

The presence of PWACR region was confirmed in one case and excluded in the other two. It was also attempted to apply the Q-PCR technique for a more accurate determination of the size of the region involved in chromosomal aberration, what would allow for a more reliable prognosing of the clinical outcome. In one of the patients, the breaking point was localized as distal to D15S144 locus, while it was proximal to D15S11 locus in the two remaining cases.

CONCLUSIONS

The obtained results demonstrate a possibility of using the Q-PCR method in diagnosing unbalanced chromosome aberrations.

Extra structurally abnormal chromosomes (ESACs)--presentation of 10 new cases

BACKGROUND

The goal of the presented studies as a retrospective reliability assessment of classical banding cytogenetic studies and of prognosing epicrises in a group of 14 cases, affected with additional marker chromosomes.

MATERIAL AND METHODS

Having collected the study material from peripheral blood, by means of trophoblast biopsy or amniocentesis, cytogenetic preparations were obtained, allowing for pre- or postnatal evaluation of the karyotype. A panel of auxiliary cytogenetic techniques accompanied the routine CTG protocol.

RESULTS

In a group of 6875 persons with recommendations to pre- or postnatal cytogenetic diagnostics, 14 (0.2%) cases of ESACs were diagnosed. In 5 cases of DA/DAPI(+) inv dup (15) as observed. A presence of polymorphic interstitial RHG(+) band was found within the marker chromosome. The measured size of that band allowed associating it with either the presence or the absence of pathological signs. In 9 cases of ESACs, DA/DAPI(-), the application of banding techniques (NOR and CBG) allowed to discover bisatellite heterochromatic ESACs in 6 cases (2 non-mosaic and 4 mosaic). In three other mosaic and non-satellite cases of ESACs, a 'genetic inactivity' of the marker chromosome was observed in one case, while a 'genetic activity' was ascertained in two cases. The 'activity' of marker chromosomes was studied by means of replication banding techniques.

CONCLUSIONS

At the time of the outburst of molecular techniques, still up-to-date is the use of classical banding techniques and of the replication techniques, allowing DNA replication kinetics studies at the level of single band.