Enhancing ACLF prediction by integrating sarcopenia assessment and frailty in liver transplant candidates on the waiting list

Background & Aims

Malnutrition, sarcopenia, and frailty are prevalent in cirrhosis. We aimed to assess the correlation between assessment tools for malnutrition, sarcopenia, and frailty in patients on the liver transplant (LT) waiting list (WL), and to identify a predictive model for acute-on-chronic liver failure (ACLF) development.

Methods

This prospective single-center study enrolled consecutive patients with cirrhosis on the WL for LT (May 2019-November 2021). Assessments included subjective global assessment, CT body composition, skeletal muscle index (SMI), ultrasound thigh muscle thickness, sarcopenia HIBA score, liver frailty index (LFI), hand grip strength, and 6-minute walk test at enrollment. Correlations were analyzed using Pearson's correlation. Competing risk regression analysis was used to assess the predictive ability of the liver- and functional physiological reserve-related variables for ACLF.

Results

A total of 132 patients, predominantly with decompensated cirrhosis (87%), were included. Our study revealed a high prevalence of malnutrition (61%), sarcopenia (61%), visceral obesity (20%), sarcopenic visceral obesity (17%), and frailty (10%) among participants. Correlations between the assessment tools for sarcopenia and frailty were poor. Sarcopenia by SMI remained prevalent when frailty assessments were not usable. After a median follow-up of 10 months, 39% of the patients developed ACLF on WL, while 28% experienced dropouts without ACLF. Multivariate analysis identified MELD-Na, SMI, and LFI as independent predictors of ACLF on the WL. The predictive model MELD-Na-sarcopenia-LFI had a C-statistic of 0.85.

Conclusions

The poor correlation between sarcopenia assessment tools and frailty underscores the importance of a comprehensive evaluation. The SMI, LFI, and MELD-Na independently predicted ACLF development in WL. These findings enhance our understanding of the relationship between sarcopenia, frailty, and ACLF in patients awaiting LT, emphasizing the need for early detection and intervention to improve WL outcomes.

Impact and implications

The relationship between sarcopenia and frailty assessment tools, as well as their ability to predict acute-on-chronic liver failure (ACLF) in patients on the liver transplant (LT) waiting list (WL), remains poorly understood. Existing objective frailty screening tests have limitations when applied to critically ill patients. The correlation between sarcopenia and frailty assessment tools was weak, suggesting that they may capture different phenotypes. Sarcopenia assessed by skeletal muscle index, frailty evaluated using the liver frailty index, and the model for end-stage liver disease-Na score independently predicted the development of ACLF in patients on the WL. Our findings support the integration of liver frailty index and skeletal muscle index assessments at the time of inclusion on the WL for LT. This combined approach allows for the identification of a specific patient subgroup with an increased susceptibility to ACLF, underscoring the importance of early implementation of targeted treatment strategies to improve outcomes for patients awaiting LT.

Chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) diagnosing equation in cirrhotic patients

Cirrhotic patients can develop acute kidney injury (AKI), and chronic kidney disease (CKD). Therefore, renal functional evaluation is crucial in cirrhotic patients. However, serum creatinine and urea levels, as well as measured or estimated glomerular filtration rate is not reliable renal functional markers in these patients compared to other patient groups. In the present study, four original equations are designed and tested for screening chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) in stable cirrhotic patients.

MATERIAL & METHOD

estimated GFR (CKD-EPI creatinine and cystatin equations) were recorded in 175 adult stable patients suffering from cirrhosis, and these patients were classified as presenting or not CKD and CKI after evaluation by two independent nephrologists. Based on these data, the variables with the significant discriminating capability to identify CKD and CKI (based on creatinine and cystatin) were detected by applying the Student's t-test for two independent groups, later confirmed by the lambda test of Wilks, in order to obtain the renal function equations.

RESULTS

CKD equation (creatinine) = 7.094238-0.043104 × CKD-EPI creatinine - 0.057537 × haematocrit. CKD equation (cystatin) = 8.375074-0.117218 × CKD-EPI cystatin. CKI equation (creatinine) = 0.428389-0.043214 × CKD-EPI creatinine +0.183051 × Child-Pugh score + 0.050162 × age (in years). CKI equation (cystatin) = 9.169579-0.139319 × CKD-EPI cystatin.

CONCLUSION

Simple and reliable equations have been obtained for screening chronic kidney disease and chronic kidney insufficiency in cirrhotic patients.

Coronary computed tomography angiography improves coronary risk prediction in general population

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute and the European Regional Development FundAgency for Management of University and Research Grants

Introduction

In the next decades, it is expected an increasing incidence of acute coronary syndrome in the Spanish population. Identify high-risk patients could be the most cost-effective way to reduce its incidence and morbi-mortality burden. We studied the effect of adding coronary artery calcification (CAC) and the extent of atherosclerotic disease (SIS score) to classical cardiovascular (CV) risk factors in coronary risk prediction.

Methods

This was a prospective cohort study of 325 asymptomatic patients recruited between 2013-2017. Demographic characteristics and CV risk factors were obtained and all participants underwent a coronary computed tomography angiography exam in which CAC and SIS were determined. The cohort was followed-up (median= 4 years) for a composite endpoint that included CV death, myocardial infarction, coronary angiography and/or revascularization. Improvement in discrimination and in reclassification by the inclusion of CAC/SIS in the Framingham-REGICOR function were examined with the Sommer's D index and with the Net reclassification index (NRI) (categorical and continuous), respectively.

Results

Nine of the 251 individuals included in the study had an event in the follow-up. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0. These participants had no events. The addition of SIS or of SIS and CAC scores to the Framigham-REGICOR risk function increased significantly the discrimination capacity from 0.71 to 0.88 (Table 1). Reclassification measured by the continuous NRI also improved significantly from 69.5 to 112.4/115.5 when SIS or both scores were included (Table 2).

Conclusions

CAC and SIS scores were associated to 4-year CV event incidence, independently of coronary risk estimation. Discrimination and reclassification of the Framigham-REGICOR coronary function were significantly improved by both indexes, but SIS overrode the effect of CAC.

Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial

BACKGROUND

The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis.

METHODS

The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178.

FINDINGS

Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population.

INTERPRETATION

The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis.

FUNDING

Boehringer Ingelheim.

Dual-sensitivity profilometry with defocused projection of binary fringes

A dual-sensitivity profilometry technique based on defocused projection of binary fringes is presented. Here, two sets of fringe patterns with a sinusoidal profile are produced by applying the same analog low-pass filter (projector defocusing) to binary fringes with a high- and low-frequency spatial carrier. The high-frequency fringes have a binary square-wave profile, while the low-frequency binary fringes are produced with error-diffusion dithering. The binary nature of the binary fringes removes the need for calibration of the projector's nonlinear gamma. Working with high-frequency carrier fringes, we obtain a high-quality wrapped phase. On the other hand, working with low-frequency carrier fringes we found a lower-quality, nonwrapped phase map. The nonwrapped estimation is used as stepping stone for dual-sensitivity temporal phase unwrapping, extending the applicability of the technique to discontinuous (piecewise continuous) surfaces. We are proposing a single defocusing level for faster high- and low-frequency fringe data acquisition. The proposed technique is validated with experimental results.

Analysing the effect of crystal size and structure in highly efficient CH3NH3PbI3 perovskite solar cells by spatially resolved photo- and electroluminescence imaging

CH3NH3PbI3 perovskite solar cells with a mesoporous TiO2 layer and spiro-MeOTAD as a hole transport layer (HTL) with three different CH3NH3I concentrations (0.032 M, 0.044 M and 0.063 M) were investigated. Strong variations in crystal size and morphology resulting in diversified cell efficiencies (9.2%, 16.9% and 12.3%, respectively) were observed. The physical origin of this behaviour was analysed by detailed characterization combining current-voltage curves with photo- and electroluminescence (PL and EL) imaging as well as light beam induced current measurements (LBIC). It was found that the most efficient cell shows the highest luminescence and the least efficient cell is most strongly limited by non-radiative recombination. Crystal size, morphology and distribution in the capping layer and in the porous scaffold strongly affect the non-radiative recombination. Moreover, the very non-uniform crystal structure with multiple facets, as evidenced by SEM images of the 0.032 M device, suggests the creation of a large number of grain boundaries and crystal dislocations. These defects give rise to increased trap-assisted non-radiative recombination as is confirmed by high-resolution μ-PL images. The different imaging techniques used in this study prove to be well-suited to spatially investigate and thus correlate the crystal morphology of the perovskite layer with the electrical and radiative properties of the solar cells and thus with their performance.

Measurement of the semileptonic charge asymmetry using B(s)(0) → D(s)μX decays

We present a measurement of the time-integrated flavor-specific semileptonic charge asymmetry in the decays of B(s)(0) mesons that have undergone flavor mixing, a(sl)(s), using B(s)(0)(B(s)(0)) → D(s)(-/+) μ(±) X decays, with D(s)(-/+) → [symbol: see text]π(-/+) and [symbol: see text]→ K(+) K(-), using 10.4 fb(-1) of proton-antiproton collisions collected by the D0 detector during Run II at the Fermilab Tevatron Collider. A fit to the difference between the time-integrated D(s)(-) and D(s)(+) mass distributions of the B(s)(0) and B(s)(0) candidates yields the flavor-specific asymmetry a(sl)(s) = [-1.12 ± 0.74(stat) ± 0.17(syst)]%, which is the most precise measurement and in agreement with the standard model prediction.

Search for the standard model Higgs boson in associated WH production in 9.7 fb(-1) of pp collisions with the D0 detector

We present a search for the standard model Higgs boson in final states with a charged lepton (electron or muon), missing transverse energy, and two or three jets, at least one of which is identified as a b-quark jet. The search is primarily sensitive to WH→ℓνbb production and uses data corresponding to 9.7 fb(-1) of integrated luminosity collected with the D0 detector at the Fermilab Tevatron pp Collider at √s = 1.96 TeV. We observe agreement between the data and the expected background. For a Higgs boson mass of 125 GeV, we set a 95% C.L. upper limit on the production of a standard model Higgs boson of 5.2 × σ(SM), where σ(SM) is the standard model Higgs boson production cross section, while the expected limit is 4.7 × σ(SM).

Combined search for the standard model Higgs boson decaying to bb using the D0 run II data set

We present the results of the combination of searches for the standard model Higgs boson produced in association with a W or Z boson and decaying into bb using the data sample collected with the D0 detector in pp collisions at √s = 1.96 TeV at the Fermilab Tevatron Collider. We derive 95% C.L. upper limits on the Higgs boson cross section relative to the standard model prediction in the mass range 100 GeV ≤ M(H) ≤ 150 GeV, and we exclude Higgs bosons with masses smaller than 102 GeV at the 95% C.L. In the mass range 120 GeV ≤ M(H) ≤145 GeV, the data exhibit an excess above the background prediction with a global significance of 1.5 standard deviations, consistent with the expectation in the presence of a standard model Higgs boson.

Search for the standard model Higgs boson in ZH→ℓ(+)ℓ(-)bb production with the D0 detector in 9.7 fb(-1) of pp collisions at √s = 1.96 TeV

We present a search for the standard model (SM) Higgs boson produced in association with a Z boson in 9.7 fb(-1) of pp collisions collected with the D0 detector at the Fermilab Tevatron Collider at √s = 1.96 TeV. Selected events contain one reconstructed Z→e(+)e(-) or Z→μ(+)μ(-) candidate and at least two jets, including at least one jet identified as likely to contain a b quark. To validate the search procedure, we also measure the cross section for ZZ production in the same final state. It is found to be consistent with its SM prediction. We set upper limits on the ZH production cross section times branching ratio for H→bb at the 95% C.L. for Higgs boson masses 90 ≤ M(H) ≤ 150 GeV. The observed (expected) limit for M(H) = 125 GeV is 7.1 (5.1) times the SM cross section.

Evidence for a particle produced in association with weak bosons and decaying to a bottom-antibottom quark pair in higgs boson searches at the tevatron

We combine searches by the CDF and D0 Collaborations for the associated production of a Higgs boson with a W or Z boson and subsequent decay of the Higgs boson to a bottom-antibottom quark pair. The data, originating from Fermilab Tevatron pp collisions at √s = 1.96 TeV, correspond to integrated luminosities of up to 9.7 fb(-1). The searches are conducted for a Higgs boson with mass in the range 100-150 GeV/c(2). We observe an excess of events in the data compared with the background predictions, which is most significant in the mass range between 120 and 135 GeV/c(2). The largest local significance is 3.3 standard deviations, corresponding to a global significance of 3.1 standard deviations. We interpret this as evidence for the presence of a new particle consistent with the standard model Higgs boson, which is produced in association with a weak vector boson and decays to a bottom-antibottom quark pair.

Search for violation of Lorentz invariance in top quark pair production and decay

Using data collected with the D0 detector at the Fermilab Tevatron Collider, corresponding to 5.3 fb(-1) of integrated luminosity, we search for violation of Lorentz invariance by examining the tt[over ¯] production cross section in lepton+jets final states. We quantify this violation using the standard-model extension framework, which predicts a dependence of the tt[over ¯] production cross section on sidereal time as the orientation of the detector changes with the rotation of the Earth. Within this framework, we measure components of the matrices (c(Q))(μν33) and (c(U))(μν33) containing coefficients used to parametrize violation of Lorentz invariance in the top quark sector. Within uncertainties, these coefficients are found to be consistent with zero.

Measurements of WW and WZ production in W + jets final states in pp collisions

We study WW and WZ production with ℓνqq (ℓ=e,μ) final states using data collected by the D0 detector at the Fermilab Tevatron Collider corresponding to 4.3  fb(-1) of integrated luminosity from pp collisions at sqrt[s]=1.96  TeV. Assuming the ratio between the production cross sections σ(WW) and σ(WZ) as predicted by the standard model, we measure the total WV (V=W,Z) cross section to be σ(WV)=19.6(-3.0)(+3.2)  pb and reject the background-only hypothesis at a level of 7.9 standard deviations. We also use b-jet discrimination to separate the WZ component from the dominant WW component. Simultaneously fitting WW and WZ contributions, we measure σ(WW)=15.9(-3.2)(+3.7)  pb and σ(WZ)=3.3(-3.3)(+4.1)  pb, which is consistent with the standard model predictions.

Measurement of the W boson mass with the D0 detector

We present a measurement of the W boson mass using data corresponding to 4.3  fb(-1) of integrated luminosity collected with the D0 detector during Run II at the Fermilab Tevatron pp collider. With a sample of 1,677,394 W → eν candidate events, we measure M(W) = 80.367 ± 0.026  GeV. This result is combined with an earlier D0 result determined using an independent Run II data sample, corresponding to 1  fb(-1) of integrated luminosity, to yield M(W) = 80.375 ± 0.023  GeV.

[Severe decompensation of hepatitis e in a patient with autoimmune hepatitis: a case report]

We report the case of a patient who initially made the diagnosis of acute hepatitis E virus with a clinical picture of jaundice with elevated liver enzymes and HEV IgM (+), but chronic evolution (More than 6 months) without being an immunosuppressed patient, forced us to exclude different causes that may produce chronic liver disease. And hypergammaglobulinemia was detected in liver biopsy: interface hepatitis, mixed inflammatory infiltrate with predominance of lymphocytes, and presence of portal-portal fibrous tracts, suggestive of severe active chronic hepatitis may be secondary to autoimmune hepatitis associated with hepatitis virus infection E. With these findings, we decided to start treatment for autoimmune hepatitis with prednisone and azathioprine, leading to a decrease in transaminases and coagulation profile to normal, which helped confirm the diagnosis of autoimmune hepatitis and decompensated manifested by acute virus infection of hepatitis E. Full report the case and a review of the literature.

Search for universal extra dimensions in pp collisions

We present a search for Kaluza-Klein (KK) particles predicted by models with universal extra dimensions (UED) using a data set corresponding to an integrated luminosity of 7.3 fb(-1), collected by the D0 detector at a pp center-of-mass energy of 1.96 TeV. The decay chain of KK particles can lead to a final state with two muons of the same charge. This signature is used to set a lower limit on the compactification scale of R(-1)>260 GeV in a minimal UED model.

Search for charged massive long-lived particles

We report on a search for charged massive long-lived particles (CMLLPs), based on 5.2  fb(-1) of integrated luminosity collected with the D0 detector at the Fermilab Tevatron pp collider. We search for events in which one or more particles are reconstructed as muons but have speed and ionization energy loss (dE/dx) inconsistent with muons produced in beam collisions. CMLLPs are predicted in several theories of physics beyond the standard model. We exclude pair-produced long-lived gauginolike charginos below 267 GeV and Higgsino-like charginos below 217 GeV at 95% C.L., as well as long-lived scalar top quarks with mass below 285 GeV.

Antioxidant status in hyperthyroid cats before and after radioiodine treatment

BACKGROUND

Reversible antioxidant depletion is found in hyperthyroid humans, and antioxidant depletion increases the risk of methimazole toxicosis in rats.

OBJECTIVES

To determine whether abnormalities in concentrations of blood antioxidants or urinary isoprostanes were present in hyperthyroid cats, and were reversible after radioiodine treatment. To determine whether or not antioxidant abnormalities were associated with idiosyncratic methimazole toxicosis.

ANIMALS

Hyperthyroid cats presented for radioiodine treatment (n = 44) and healthy mature adult control cats (n = 37).

METHODS

Prospective, controlled, observational study. Red blood cell glutathione (GSH), plasma ascorbate (AA), plasma free retinol (vitamin A), α-tocopherol (vitamin E), and urinary free 8-isoprostanes in hyperthyroid cats were compared to healthy cats and to hyperthyroid cats 2 months after treatment.

RESULTS

Blood antioxidants were not significantly different in hyperthyroid cats (mean GSH 1.6 ± 0.3 mM; AA 12.8 ± 4.9 μM, and vitamin E, 25 ± 14 μg/mL) compared to controls (GSH 1.4 ± 0.4 mM; AA 15.0 ± 6.6 μM, and vitamin E, 25 ± 17 μg/mL). Urinary isoprostanes were increased in hyperthyroid cats (292 ± 211 pg/mg creatinine) compared to controls (169 ± 82 pg/mg; P = .006), particularly in hyperthyroid cats with a USG < 1.035. Plasma free vitamin A was higher in hyperthyroid cats (0.54 ± 0.28 μg/mL versus 0.38 ± 0.21 in controls; P = .007). Both abnormalities normalized after radioiodine treatment. No association was found between oxidative status and prior idiosyncratic methimazole toxicosis.

CONCLUSION AND CLINICAL IMPORTANCE

Increased urinary isoprostane could reflect reversible renal oxidative stress induced by hyperthyroidism, and this requires additional evaluation.

Evidence for spin correlation in t ̅t production

We present a measurement of the ratio of events with correlated t and t ̅t spins to the total number of t ̅t events. This ratio f is evaluated using a matrix-element-based approach in 729 t ̅t candidate events with a single lepton ℓ (electron or muon) and at least four jets. The analyzed p ̅p collisions data correspond to an integrated luminosity of 5.3 fb(-1) and were collected with the D0 detector at the Fermilab Tevatron collider operating at a center-of-mass energy √s=1.96 TeV. Combining this result with a recent measurement of f in dileptonic final states, we find f in agreement with the standard model. In addition, the combination provides evidence for the presence of spin correlation in t ̅t events with a significance of more than 3 standard deviations.

Search for doubly charged Higgs boson pair production in pp¯ collisions at √s=1.96 TeV

We present a search for pair production of doubly charged Higgs bosons in the processes qq¯→H(++)H(--) decaying through H(±±)→τ(±)τ(±),μ(±)τ(±),μ(±)μ(±). The search is performed in pp¯ collisions at a center-of-mass energy of √s = 1.96 TeV using an integrated luminosity of up to 7.0 fb(-1) collected by the D0 experiment at the Fermilab Tevatron Collider. The results are used to set 95% C.L. limits on the pair production cross section of doubly charged Higgs bosons and on their mass for different H(±±) branching fractions. Models predicting different H(±±) decays are investigated. Assuming B(H(±±)→τ(±)τ(±))=1 yields an observed (expected) lower limit on the mass of a left-handed H(L)(±±) boson of 128 (116) GeV and assuming B(H(±±)→μ(±)τ(±))=1 the corresponding limits are 144 (149) GeV. In a model with B(H(±±)→τ(±)τ(±))=B(H(±±)→μ(±)τ(±))=B(H(±±)→μ(±)μ(±))=1/3, we obtain M(H(L)(±±))>130 (138) GeV.

P5-11-10: Reproducibility and Robustness of the FDA Approved INFORM HER2 Dual ISH DNA Probe Cocktail Assay

Background: Amplification and/or HER2 overexpression is associated with poor clinical outcome for patients with invasive breast carcinoma. Determination of HER2 status dictates eligibility of patients for trastuzumab (Herceptin) therapy, which has been shown to improve prognosis. We present data from the inter-observer reproducibility and robustness studies of the FDA approved INFORM HER2 Dual ISH DNA Probe Cocktail (HER2 Dual ISH) assay, which is an alternative to FISH. The assay is fully automated and is scored using light microscopy providing morphological context.

Methods: Ninety-five human invasive breast carcinoma specimens (a mix of amplified and non-amplified cases) were stained in a study, using the HER2 Dual ISH assay. The slides were enumerated by two qualified readers. The same cohort was stained using Path Vysion FISH and read by one qualified reader.

To verify the robustness of the HER2 Dual ISH assay, customer selectable options for factors known to impact the staining quality and intensity, which can be varied for troubleshooting, were tested on human invasive breast carcinoma cases and xenografts. The slides were evaluated by one qualified reader.

For both studies all assay steps were fully automated on a VENTANA BenchMark XT automated slide stainer using silver metallographic and red colorimetric detections for Dual ISH.

Results: In the inter-observer study the first pass staining success rate was &gt;93% for the HER2 Dual ISH assay, while the FISH first pass staining success rate was 59%. Some cases were rescued after a second attempt, which yielded a second pass staining success rate of 80% for FISH and 97% for HER2 Dual ISH. The negative, positive and overall agreement rates and 95% confidence intervals for the 61 clinical samples of this cohort that were enumerable with both FISH and the HER2 Dual ISH assay are 94.7 (75.4−99.1), 95.2 (84.2−98.7), 95.1 (86.5−98.3) and 89.5 (68.6−97.1), 97.6 (87.7−99.6), 95.1 (86.5−98.3) for reader A vs. FISH and reader B vs. FISH respectively. The positive and negative agreement rates for the inter-observer reproducibility of the HER2 Dual ISH assay were 94.7 and 97.6 %, respectively. In robustness testing, the recommended staining protocol was shown to be effective. All conditions tested resulted in appropriate staining (except for mildest cell conditioning and protease options). Conclusion: The fully automated FDA approved INFORM HER2 Dual ISH assay is robust, reproducible and concordant with the manual FISH assay in determining HER2 status in invasive breast carcinoma.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-10.

Wγ production and limits on anomalous WWγ couplings in pp collisions at sqrt[s] = 1.96 TeV

We measure the cross section and the difference in rapidities between photons and charged leptons for inclusive W(→lν) + γ production in eγ and μγ final states. Using data corresponding to an integrated luminosity of 4.2  fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider, the measured cross section times branching fraction for the process pp → Wγ + X → lνγ + X and the distribution of the charge-signed photon-lepton rapidity difference are found to be in agreement with the standard model. These results provide the most stringent limits on anomalous WWγ couplings for data from hadron colliders: -0.4<Δκ(γ)<0.4 and -0.08<λ(γ)<0.07 at the 95% C.L.

Search for a fermiophobic and standard model Higgs boson in diphoton final states

We present a search for the standard model Higgs boson and a fermiophobic Higgs boson in the diphoton final states based on 8.2  fb(-1) of pp collisions at sqrt[s]=1.96  TeV collected with the D0 detector at the Fermilab Tevatron Collider. No excess of data above background predictions is observed and upper limits at the 95% C.L. on the cross section multiplied by the branching fraction are set which are the most restrictive to date. A fermiophobic Higgs boson with a mass below 112.9 GeV is excluded at the 95% C.L.

The INFORM HER2 Dual ISH assay compared with FISH to determine HER2 gene status in invasive breast carcinoma

25

Background: The HER2 gene, located on chromosome 17 (Chr17), is amplified in 15-25% of patients with invasive breast carcinoma. Amplification and/or HER2 overexpression is associated with poor clinical outcome for these patients; however prognosis is improved if HER2 status indicates eligibility of patients for trastuzumab therapy. Thus, accurate diagnosis of HER2 status through a companion diagnostic is essential. Here we validated the INFORM HER2 Dual ISH Probe Cocktail (Dual ISH) assay as an alternative to FISH, the current gold standard for HER2 testing. The Dual ISH assay is fully automated and is scored using light microscopy.

Methods: A multi-site method comparison and inter-laboratory reproducibility study were performed. 5 sites were used to compare Dual ISH results with FISH (Vysis PathVysion). 510 invasive breast carcinoma cases were stained at 3 clinical sites, FISH staining was performed at a fourth site (central laboratory). IHC status was determined at a fifth site (second central laboratory). In addition, 6 cases were evaluated for inter-site (3 sites), inter-reader (6 readers), inter-run (15 runs) and intra-run (duplicate slides) reproducibility. All assay steps were fully automated on a VENTANA BenchMark XT automated slide stainer, using a HER2 repeat-reduced, dinitrophenyl-labeled probe targeting the HER2 gene, detected with silver metallographic detection, and a digoxigenin-labeled Chr 17 probe, detected by an alkaline phosphatase-driven red chromogenic detection. HER2 and CHR17 signals were enumerated using conventional light microscopy allowing interpretation within the morphological context of the specimen. HER2 status was determined as the ratio of HER2/Chr17, where a ratio <2 is non-amplified and a ratio ≥2 is amplified.

Results: The positive and negative agreement rates with FISH (95% CI) were 96% (92.6-97.9) and 92.3% (88.6-94.8), respectively. The HER2 Dual ISH assay also was highly reproducible in determining HER2/Chr17 ratio across sites, days, readers and runs.

Conclusions: The fully automated INFORM HER2 Dual ISH assay is reproducible and concordant with the manual FISH assay in determining HER2 status in invasive breast carcinoma.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs produced in association with b quarks in pp collisions at √s = 1.96 TeV

We report results from a search for neutral Higgs bosons produced in association with b quarks using data recorded by the D0 experiment at the Fermilab Tevatron Collider and corresponding to an integrated luminosity of 7.3 fb(-1). This production mode can be enhanced in several extensions of the standard model (SM) such as in its minimal supersymmetric extension (MSSM) at high tanβ. We search for Higgs bosons decaying to tau pairs with one tau decaying to a muon and neutrinos and the other to hadrons. The data are found to be consistent with SM expectations, and we set upper limits on the cross section times branching ratio in the Higgs boson mass range from 90 to 320 GeV/c(2). We interpret our result in the MSSM parameter space, excluding tanβ values down to 25 for Higgs boson masses below 170 GeV/c(2).

Precision measurement of the ratio B(t→Wb)/B(t→Wq) and extraction of V(tb)

We present a measurement of the ratio of top quark branching fractions R=B(t→Wb)/B(t→Wq), where q can be a d, s, or b quark, in the lepton+jets and dilepton tt final states. The measurement uses data from 5.4 fb(-1) of pp collisions collected with the D0 detector at the Fermilab Tevatron Collider. We measure R=0.90±0.04, and we extract the Cabibbo-Kobayashi-Maskawa (CKM) matrix element |V(tb)| as |V(tb)|=0.95±0.02, assuming unitarity of the 3×3 CKM matrix.

Search for a fourth generation t' Quark in p ̄p collisions at √s = 1.96 TeV

We present a search for pair production of a fourth generation t' quark and its antiparticle, followed by their decays to a W boson and a jet, based on an integrated luminosity of 5.3 fb(-1) of proton-antiproton collisions at √s = 1.96  TeV collected by the D0 Collaboration at the Fermilab Tevatron Collider. We set upper limits on the t' ̄t' production cross section that exclude at the 95% C.L. a t' quark that decays exclusively to W+jet with a mass below 285 GeV. We observe a small excess in the μ+jets channel which reduces the mass range excluded compared to the expected limit of 320 GeV in the absence of a signal.

Precise measurement of the top quark mass in the dilepton channel at D0

We measure the top quark mass (m(t)) in p ̄p collisions at a center of mass energy √s = 1.96 TeV using dilepton t ̄t→W(+)bW(-) ̄b→ℓ(+)ν(ℓ)bℓ(-) ̄ν(ℓ) ̄b events, where ℓ denotes an electron, a muon, or a tau that decays leptonically. The data correspond to an integrated luminosity of 5.4 fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider. We obtain m(t)=174.0±1.8(stat)±2.4(syst) GeV, which is in agreement with the current world average m(t)=173.3±1.1 GeV. This is currently the most precise measurement of m(t) in the dilepton channel.

Measurement of spin correlation in tt production using a matrix element approach

We determine the fraction of tt events with spin correlation, assuming that the spin of the top quark is either correlated with the spin of the top antiquark as predicted by the standard model or is uncorrelated. For the first time we use a matrix-element-based approach to study tt spin correlation. We use tt → W+ b W- b → ℓ+ νbℓ- ν b final states produced in pp collisions at a center-of-mass energy sqrt(s)=1.96  TeV, where ℓ denotes an electron or a muon. The data correspond to an integrated luminosity of 5.4  fb(-1) and were collected with the D0 detector at the Fermilab Tevatron collider. The result agrees with the standard model prediction. We exclude the hypothesis that the spins of the tt are uncorrelated at the 97.7% C.L.

Search for Resonant WW and WZ Production in pp collisions at √s=1.96 TeV

We search for resonant WW or WZ production by using up to 5.4 fb(-1) of integrated luminosity collected by the D0 experiment in run II of the Fermilab Tevatron Collider. The data are consistent with the standard model background expectation, and we set limits on a resonance mass by using the sequential standard model W' boson and the Randall-Sundrum model graviton G as benchmarks. We exclude a sequential standard model W' boson in the mass range 180-690 GeV and a Randall-Sundrum graviton in the range 300-754 GeV at 95% C.L.

Bounds on an anomalous dijet resonance in W+jets production in pp collisions at √s = 1.96 TeV

We present a study of the dijet invariant mass spectrum in events with two jets produced in association with a W boson in data corresponding to an integrated luminosity of 4.3 fb(-1) collected with the D0 detector at √s = 1.96 TeV. We find no evidence for anomalous resonant dijet production and derive upper limits on the production cross section of an anomalous dijet resonance recently reported by the CDF Collaboration, investigating the range of dijet invariant mass from 110 to 170 GeV/c(2). The probability of the D0 data being consistent with the presence of a dijet resonance with 4 pb production cross section at 145 GeV/c(2) is 8×10(-6).

Search for the standard model Higgs boson in the H→WW→lνq'q decay channel

We present a search for the standard model Higgs boson (H) in pp collisions at sqrt(s)=1.96  TeV in events containing a charged lepton (ℓ), missing transverse energy, and at least two jets, using 5.4  fb(-1) of integrated luminosity recorded with the D0 detector at the Fermilab Tevatron Collider. This analysis is sensitive primarily to Higgs bosons produced through the fusion of two gluons or two electroweak bosons, with subsequent decay H→WW→ℓνq'q, where ℓ is an electron or muon. The search is also sensitive to contributions from other production channels, such as WH→ℓνbb. In the absence of a signal, we set limits at the 95% C.L. on the cross section for H production σ(pp→H+X) in these final states. For a mass of M(H)=160  GeV, the limit is a factor of 3.9 larger than the cross section in the standard model and consistent with an a priori expected sensitivity of 5.0.

Precise study of the Z/γ* boson transverse momentum distribution in pp collisions using a novel technique

Using 7.3 fb⁻¹ of pp collisions collected by the D0 detector at the Fermilab Tevatron, we measure the distribution of the variable φ(η)*, which probes the same physical effects as the Z/γ* boson transverse momentum, but is less susceptible to the effects of experimental resolution and efficiency. A QCD prediction is found to describe the general features of the φ(η)* distribution, but is unable to describe its detailed shape or dependence on boson rapidity. A prediction that includes a broadening of transverse momentum for small values of the parton momentum fraction is strongly disfavored.

Search for single vectorlike quarks in pp ̄ collisions at √s=1.96 TeV

We present a search for hypothetical vectorlike quarks in pp ̅ collisions at √s=1.96  TeV. The data were collected by the D0 detector at the Fermilab Tevatron Collider and correspond to an integrated luminosity of 5.4  fb(-1). We select events with a final state composed of a W or Z boson and a jet consistent with a heavy object decay. We observe no significant excess in comparison to the background prediction and set limits on production cross sections for vectorlike quarks decaying to W+jet and Z+jet. These are the most stringent limits to date for electroweak single vectorlike quark production at hadron colliders.

Determination of the width of the top quark

We extract the total width of the top quark, Γ(t), from the partial decay width Γ(t → Wb) measured using the t-channel cross section for single top-quark production and from the branching fraction B(t → Wb) measured in tt events using up to 2.3  fb(-1) of integrated luminosity collected by the D0 Collaboration at the Tevatron pp Collider. The result is Γ(t) = 1.99(-0.55)(+0.69)  GeV, which translates to a top-quark lifetime of τ(t) = (3.3(-0.9)(+1.3)) × 10(-25)   s. Assuming a high mass fourth generation b' quark and unitarity of the four-generation quark-mixing matrix, we set the first upper limit on |V(tb')| < 0.63 at 95% C.L.

Search for ZH → l+ l- bb production in 4.2 fb(-1) of pp collisions at sqrt[s] =1 .96 TeV

We present a search for the standard model Higgs boson produced in association with a Z boson in 4.2 fb(-1) of pp collisions, collected with the D0 detector at the Fermilab Tevatron at sqrt[s] =1 .96 TeV. Selected events contain one reconstructed Z → e+ e- or Z → μ+ μ- candidate and at least two jets, including at least one b-tagged jet. In the absence of an excess over the background expected from other standard model processes, limits on the ZH cross section multiplied by the branching ratios are set. The limit at M(H) = 115  GeV is a factor of 5.9 larger than the standard model prediction.

Search for diphoton events with large missing transverse energy in 6.3 fb(-1) of pp collisions at √s=1.96 TeV

We report a search for diphoton events with large missing transverse energy produced in pp collisions at √s=1.96  TeV. The data were collected with the D0 detector at the Fermilab Tevatron Collider and correspond to 6.3  fb(-1) of integrated luminosity. The observed missing transverse energy distribution is well described by the standard model prediction, and 95% C.L. limits are derived on two realizations of theories beyond the standard model. In a gauge-mediated supersymmetry breaking scenario, the breaking scale Λ is excluded for Λ<124  TeV. In a universal extra dimension model including gravitational decays, the compactification radius R(c) is excluded for R(c)(-1)<477  GeV.

Search for new fermions ("quirks") at the Fermilab Tevatron collider

We report results of a search for particles with anomalously high ionization in events with a high transverse energy jet and large missing transverse energy in 2.4 fb⁻¹ of integrated luminosity collected by the D0 experiment at the Fermilab Tevatron pp collider. Production of such particles (quirks) is expected in scenarios with extra QCD-like SU(N) sectors, and this study is the first dedicated search for such signatures. We find no evidence of a signal and set a lower mass limit of 107, 119, and 133 GeV for the mass of a charged quirk with strong dynamics scale Λ in the range from 10 keV to 1 MeV and N=2, 3, and 5, respectively.

Search for events with leptonic jets and missing transverse energy in pp collisions at √s=1.96 TeV

We present the first search for pair production of isolated jets of charged leptons in association with a large imbalance in transverse energy in pp collisions using 5.8 fb⁻¹ of integrated luminosity collected by the D0 detector at the Fermilab Tevatron Collider. No excess is observed above the standard model background, and the result is used to set upper limits on the production cross section of pairs of supersymmetric chargino and neutralino particles as a function of "dark-photon" mass, where the dark photon is produced in the decay of the lightest supersymmetric particle.

Search for sneutrino production in eμ final states in 5.3 fb-1 of pp collisions at square root s =1.96 TeV

We report the results of a search for R parity violating (RPV) interactions leading to the production of supersymmetric sneutrinos decaying into eμ final states using 5.3 fb-1 of integrated luminosity collected by the D0 experiment at the Fermilab Tevatron Collider. Having observed no evidence for production of eμ resonances, we set direct bounds on the RPV couplings λ311' and λ312 as a function of sneutrino mass.

Evidence for an anomalous like-sign dimuon charge asymmetry

We measure the charge asymmetry A ≡ (N++ - N--)/(N++ + N--) of like-sign dimuon events in 6.1 fb-1 of pp collisions recorded with the D0 detector at a center-of-mass energy square root(s) = 1.96   TeV at the Fermilab Tevatron collider. From A we extract the like-sign dimuon charge asymmetry in semileptonic b-hadron decays: A(sl)(b) = -0.009 57 ± 0.002 51(stat) ± 0.001 46(sys). It differs by 3.2 standard deviations from the standard model prediction A(sl)(b)(SM) = (-2.3(-0.6)(+0.5)) × 10(-4), and provides first evidence of anomalous CP violation in the mixing of neutral B mesons.