Mental Health Disorders among Children and Associated Parental Stress: A Cross-Sectional Study in Pediatric OPD of Burdwan Medical College, West Bengal

Background

Identification of mental health disorders during childhood is crucial for healthy 'adult roles' in the society, so this study aimed to estimate the magnitude of 'any mental health disorder' and to find out its correlates among children attending the pediatric out-patient department (OPD) of a medical college in West Bengal and to estimate parental stress among their parents.

Materials and Methods

It was a descriptive cross-sectional study done in the pediatric OPD of Burdwan Medical College, West Bengal, during July-December, 2021. The calculated size of 288 children aged between 4 and 12 years and attending with either of their parents was selected through systematic random sampling. One of their parents (preferably mother) was interviewed using a schedule, containing a pre-validated pediatric symptom checklist and parental stress scale. Ethical clearance was obtained from the Institutional Ethics Committee. Data were analyzed using SPSS-v23.

Results

The median age of the children was 7 years (5-8 y.). The majority of them were male (57.6%), lived in urban areas (59.0%), and lived in joint families (57.6%). One-fifth (20.5%) of the children were found to have any mental health disorder (AMHD). Living in an urban area (aOR = 2.5, 95% CI: 1.1-5.7), belonging to a nuclear family (aOR = 3.6, 95% CI: 1.7-8.1), and belonging to a family with social problems (aOR = 7.8, 95% CI: 2.3-27.2) were significant correlates of AMHD. Parental stress [median: 60 (55-63)] was found significantly higher (P < 0.001) among parents of children with AMHD as compared to the parents of others.

Conclusion

The magnitude of AMHD was high in this study, indicating toward the necessity of implementing opportunistic screening and appropriate public health action.

Epithelial myoepithelial carcinoma of the parotid gland with high-grade transformation

A woman presented with a painless swelling in front of her right auricle, which, on examination, seemed to be a hard, immobile mass arising from the right parotid gland. CT scan showed a heterogeneously enhancing mass lesion in the superficial lobe of the parotid gland with partial extension into the deep lobe. Fine needle aspiration cytology suggested a high-grade transformation (HGT) with the presence of bizarre tumour cells. She underwent a right-sided total parotidectomy with transient facial neuropraxia in the postoperative period. The final pathological diagnosis of the specimen came out to be epithelial myoepithelial carcinoma with HGT, which is a relatively rare entity, with no defined guidelines for management. Our patient was managed by surgical resection alone without any postoperative radiation therapy, and short-term follow-up results seem to suggest no recurrence.

Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center

Objectives

Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients.

Material and Methods

The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days.

Results

A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p <0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p <0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care.

Conclusion

We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.

Penile Ewing's Sarcoma - A Rare Entity

Introduction/Objective

Ewing sarcoma is a cancer involving the bones or the tissue around bones. It is the second most common malignant bone tumour comprising 10-15% of all primary bone tumours, most commonly affecting children and young adults. It can also be seen in adults also. Males are more commonly affected then females. Any bone can be affected but the lower extremity, the pelvis, upper extremity, axial skeleton and ribs, and face cases. Similar histology tumours when seen in soft tissue are peripheral primitive neuroectodermal tumour (pPNET), neuroepithelioma, and Askin tumour. It is always difficult to know the primary site when soft tissues are involved as it can be infiltration from bone or from soft tissue to bone. Penis is least common site involved with Ewing’s sarcoma in young male.

Methods/Case Report

This is a case report of a 22 year old male with penile lesion. He presented with the chief complaints of mass at the shaft of penis. The partial penectomy specimen was received along with the bilateral inguinal lymph node. On gross there was a ulcero-proliferative growth.

Results (if a Case Study Enter NA)

On histopathological examination showed small blue round cell tumour and further immunohistochemistry with CD99 and NKX2.2 revealed the diagnosis of Ewing’s sarcoma, however lymph nodes showed reactive lymphoid hyperplasia.

Conclusion

The Ewing sarcoma at the penile region is rarest entity. Only 7 cases are reported worldwide. The imaging modalities like CT or MRI can be used to know the extension. The diagnosis is primarily based on morphological features, immunohistochemical analysis and translocation analysis. However it is important to find out if any other soft tissue site is involved. The important prognostic markers are presence and absence of metastasis, size of tumour, necrosis and presence of fusion transcripts.

OC-003 PORT POSITIONS IN TEP FOR SHORT PATIENTS: OUR EXPERIENCE

Introduction

Totally extraperitoneal repair (TEP) is a popular technique for repair of inguinal hernia. One common technique of TEP involves placement of one 10 mm port 1–2 cm below the umbilicus just off the midline, one 5 mm port 2–3 cm above the pubic symphysis, and a third 5 mm port between these 2 ports in the midline (Figure 1a). In case the distance from the superior border of the symphysis pubis to the inferior edge of the umbilicus is less than 15 cm, this leads to crowding of instruments and results in ergonomic problems during the operation. Daes has popularized eTEP for this indication. The aim is to shift the first 10 mm port to a position 5 cm superior and 4 cm lateral to the umbilicus (Figure 1b). eTEP has also found application in the repair of ventral hernias. However, for most inguinal hernias, we feel that eTEP is an overkill.

Methods

We place the first 10 mm port at the level of the superior border of the umbilicus and just lateral to it (Figure 1c). The two 5 mm ports are placed in the midline. Initial dissection is performed telescopically.

Results

This technique provides 2–3 cm of extra working space, which improves ergonomics while operating on patients with a short pubo-umbilical distance. Other parameters like operating time, postoperative pain and other complications remain the same.

Conclusion

We recommend placement of the 10 mm port at the superior border of the umbilicus, particularly in short patients.

Isoniazid preventive therapy among child contacts of TB patients, India

BACKGROUND: Isoniazid preventive therapy (IPT) for child contacts of TB patients, a globally accepted intervention, needs to be evaluated in diverse geographical regions.OBJECTIVES: To assess the extent of IPT coverage and adherence, to ascertain its sociodemographic and programmatic correlates and to explore existing constraints from service providers and beneficiaries´ perspectives.METHODS: A mixed-method study was conducted in January-June 2021 in Paschim Bardhaman District, West Bengal, India. Quantitative assessment was done among 280 child contacts of TB cases registered between January and December 2020 in all TB units in the district. Primary caregivers were interviewed using a pre-designed questionnaire. Two focus group discussions with all senior treatment supervisors of the district and in-depth interviews with 12 purposively selected caregivers of the children were undertaken. Qualitative data were analysed thematically.RESULTS: Only 48.9% (137/280) of child contacts were screened; 58.9% (165/280) were initiated on IPT and 40% (66/165) adhered to a full course. Coverage of the full 6-month IPT among total study participants was 23.6% (66/280). Household visits by health personnel and initial screening significantly predicted increased coverage. Programmatic inadequacies, poor understanding, social stigma and COVID situation were major constraints.CONCLUSION: Coverage of IPT remains unacceptably low and requires health system strengthening for effectively implementing current recommendations of TB preventive treatment.

Are home environment injuries more fatal in children and the elderly?

INTRODUCTION

'In-home injuries' are those that occur within the house or its immediate surroundings. The literature on the prevalence and magnitude of home injuries is sparse. This study was designed to characterize the mechanisms of 'in-home' injuries and compare their outcomes with 'outside home injuries'.

MATERIALS AND METHODS

The Australia-India Trauma Systems Collaboration (AITSC) Project created a multicentric registry consisting of trauma patients admitted at four urban tertiary care hospitals in India from April 2016 to March 2018. This registry data was analysed for this study. All admitted patients except for dead on arrival were included. Patients were categorised into 'in-home' and 'outside home' cohorts based on the place where the trauma occurred. The outcome measures were 30 day in-hospital mortality and the length of hospital stay. Two subgroup analyses were performed, the first comprised pediatric patients (<15 years) and the second elderly patients >64 years).

RESULTS

Among 9354 patients in the AITSC data registry, 8398 patients were included in the study. Out of these, 29 percent were in-home injuries, whereas the rest occurred outside home. The 30 day in-hospital mortality was 10.6 percent in the 'in-home' cohort, as compared to 13.7 percent in the 'outside home' cohort. This difference although significant on univariable analysis (p <0.01), there was no significant difference on multivariable regression analysis, after adjusting for age and injury severity score (OR = 0.88, 95% CI = 0.73-1.04; p = 0.15). The length of hospital stay was shorter in the home injuries group (median = 5 days; IQR = 3-12 days) compared to the outside-home group (median = 7 days; IQR = 4-14 days) (p < 0.01). In the pediatric and the elderly, on multivariable regression analysis, in-home injuries were associated with higher mortality than outside home injuries.

CONCLUSION

There was no significant difference in the 30 day in-hospital mortality amongst admitted trauma patients sustaining injuries at home or outside the home. However, in pediatric and elderly patients the chances of mortality was significantly higher when injured at home.

Vaccine hesitancy in case of under-5 vaccination in slums of Burdwan Municipality, West Bengal: A cross-sectional study

Background: There are multiple reasons for which a considerable proportion of the population remains unvaccinated, including vaccine hesitancy. Identifying the reasons behind vaccine hesitancy, especially in marginalized population, is essential. Aims and Objectives: The aims of the study were to estimate the magnitude and determinants of vaccine hesitancy related to under-5 vaccination in slums of Burdwan Municipality, West Bengal. Materials and Methods: A community-based descriptive study with cross-sectional design was conducted between September 2020 and January 2021 among 135 study subjects (under-5 children) selected by multistage random sampling. Data were collected by interviewing the primary caregivers of selected children using a predesigned schedule including vaccine hesitancy survey questionnaire by Strategic Advisory Group of Experts. Data analysis was done using SPSS v.20. Results: Vaccine hesitancy was found in case of 11.9% of the study subjects. Refusal was seen in 2.2%, only in case of birth doses, whereas hesitancy due to delay was seen in 9.7% in case of MR, JE, DPT, and OPV boosters. Stated reasons for hesitancy were – “vaccine was not needed” (47.4%), “fear of needles” (31.5%), and “not able to leave other work at home” (21.1%). Caregivers of 17% of the study subjects faced difficulty from getting their child immunized mainly due to timing of the clinic and lockdown. The presence of vaccine hesitancy was not associated with sociodemographic characteristics of the child or of the caregivers. Conclusion: Vaccine hesitancy was found to be low in the study area, it was mainly to birth doses and mostly due to lack of awareness among caregivers.

Exploring challenges of teenage pregnancy and motherhood from beneficiaries and providers' perspectives: A qualitative study in a rural area of Purba Bardhaman District, West Bengal

Context

Teenage pregnancy and motherhood are globally important public health concerns. In India, 6.8% women between 15 and 19 years were already mothers or pregnant, whereas in Purba-Bardhaman district of West Bengal it was 21.9% (National-Family-Health-Survey-5). Challenges of teenage pregnancy and motherhood needs to be understood from beneficiaries' and providers' perspectives.

Aims

This study aimed at exploring the various challenges faced by teenagers during their pregnancies and motherhood and understanding the barriers of service delivery to them in a block of West Bengal.

Settings and Design

A qualitative study with phenomenological approach was conducted between January and June 2021 in Bhatar community development block of Purba-Bardhaman district, West Bengal.

Methods and Material

In-depth interview (IDI) of 12 purposively selected teenage mothers and two sessions of Focus Group Discussions (FGDs) among 17 Auxiliary Nurse Midwives (ANMs) were conducted. Data was collected by audio recording the IDI and FGD sessions as well as by taking notes.

Analysis Used

Inductive thematic analysis was done by using NVIVO software (Release 1.0, QSR International).

Results

Throughout teenage pregnancy and motherhood, subjects were found to face various types of medical problems, lack of awareness, and non-supportive family environment. Various social constraints and psychosocial stressors emerged as significant challenges. Communication gaps, behavioural barriers, socio-cultural issues, and administrative issues were major themes emerged as barriers of service delivery.

Conclusions

Lack of awareness and medical problems were important challenges faced by the teenage mothers whereas behavioural barriers were the most important service level barriers perceived by the grass root level service providers.

Post-COVID-19 Intestinal and Mesenteric Mucormycosis

A thirty-eight-year-old uncontrolled diabetic with a recent COVID-19 infection presented with extensive bowel ischemia and gangrene with a microscopic diagnosis of intestinal and mesenteric mucormycosis. Although there are a few reported cases of primary gastrointestinal mucormycosis, our case showing involvement of the intestine and/or mesentery, that too in a post-COVID patient, is quite uncommon. The immunosuppressive effect of the COVID-19 disease, uncontrolled diabetes, and the use of corticosteroids for the treatment of severe COVID are the most probable reasons for the emergence of severe opportunistic infections, both as a coinfection and as a sequalae to COVID.

Impact of COVID-19 pandemic on psychological health and quality of sleep: An online survey from Kolkata

Background: As a preventive measure to combat COVID-19 pandemic, India has undergone “lockdown” since March 25, 2020. The pandemic and lockdown can impose a psychological impact in the form of fear, anxiety, stress and insomnia etc. Aims and Objective: The aim of the current study is to assess the magnitude of anxiety, depression, stress and poor sleep quality among the adult population of Kolkata, West Bengal amidst COVID-19 pandemic. Materials and Methods: By this online survey using Google forms, a total of 435 responses were received. The online questionnaire comprises of Socio-demographic characteristics, COVID—19 Anxiety Scale (CAS), Perceived Stress Scale 4 (PSS 4), Patient Health Questionnaire-9 (PHQ 9) and Insomnia Severity Index (ISI). Results: COVID-19 related anxiety were almost similar across age groups, sex, marital and educational status. PSS score was found higher in ≤25 years and >40 years age group, those not currently married, students and homemakers. Patient Health Questionnaire scores were found significantly different across all background characteristics categories except for the level of education whereas Insomnia Severity index Scale scores were found significantly more among subjects not currently married and among subjects who were working from home. Conclusions: The current study provides evidence towards the negative psychological impact of the pandemic and reminds us about the need for widespread psychiatric services during and after pandemic.

Superconductivity assisted change of the perpendicular magnetic anisotropy in V/MgO/Fe junctions

Controlling the perpendicular magnetic anisotropy (PMA) in thin films has received considerable attention in recent years due to its technological importance. PMA based devices usually involve heavy-metal (oxide)/ferromagnetic-metal bilayers, where, thanks to interfacial spin-orbit coupling (SOC), the in-plane (IP) stability of the magnetisation is broken. Here we show that in V/MgO/Fe(001) epitaxial junctions with competing in-plane and out-of-plane (OOP) magnetic anisotropies, the SOC mediated interaction between a ferromagnet (FM) and a superconductor (SC) enhances the effective PMA below the superconducting transition. This produces a partial magnetisation reorientation without any applied field for all but the largest junctions, where the IP anisotropy is more robust; for the smallest junctions there is a reduction of the field required to induce a complete OOP transition (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$H_\text {OOP}$$\end{document}HOOP) due to the stronger competition between the IP and OOP anisotropies. Our results suggest that the degree of effective PMA could be controlled by the junction lateral size in the presence of superconductivity and an applied electric field. We also discuss how the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$H_\text {OOP}$$\end{document}HOOP field could be affected by the interaction between magnetic stray fields and superconducting vortices. Our experimental findings, supported by numerical modelling of the ferromagnet-superconductor interaction, open pathways to active control of magnetic anisotropy in the emerging dissipation-free superconducting spin electronics.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

Developmental delay among children under two years of age in slums of Burdwan Municipality: A cross-sectional study

Context:

Development is an ongoing process through which an individual acquires competence to function adequately. Developmental delay is said to occur when a child fails to reach the age-appropriate anticipated milestones. This imparts long-term direct as well as indirect effects on the health of a community obviating routine measurement of its prevalence especially in high-risk populations.

Aim:

To find out the prevalence and correlates of developmental delay among children under two years of age in slums of Burdwan Municipality, West Bengal.

Settings and Design:

A community-based descriptive cross-sectional study.

Methods and Materials:

This study was conducted between September-November 2019 among 240 study subjects selected by multistage simple random sampling. Data were collected by interviewing the respondents using a predesigned, pretested schedule. Developmental status was assessed by applying Trivandrum Developmental Screening Chart (TDSC). Chi-square test and logistic regression was done to find associations.

Results:

Prevalence of developmental delay was 6.6%(95%CI 3.6-9.8) and proportion was more among male infants. Chi square test revealed gender (p = 0.03), mothers' education (p = 0.00), socio-economic status (p = 0.00), parity (p = 0.02), birth spacing (p = 0.01) birth weight (p = 0.00) to be significantly associated with developmental delay and multivariable analysis showed all the factors to be significant predictors except gender, parity and birth spacing. Gestational duration, maternal age at delivery, mode of delivery was not found to be significantly associated with developmental delay.

Conclusion:

Developmental delay is considerably high in the study area. A larger study using appropriate tool and follow-up may elicit the burden and associated determinants.

Strain driven emergence of topological non-triviality in YPdBi thin films

Half-Heusler compounds exhibit a remarkable variety of emergent properties such as heavy-fermion behaviour, unconventional superconductivity and magnetism. Several of these compounds have been predicted to host topologically non-trivial electronic structures. Remarkably, recent theoretical studies have indicated the possibility to induce non-trivial topological surface states in an otherwise trivial half-Heusler system by strain engineering. Here, using magneto-transport measurements and first principles DFT-based simulations, we demonstrate topological surface states on strained [110] oriented thin films of YPdBi grown on (100) MgO. These topological surface states arise in an otherwise trivial semi-metal purely driven by strain. Furthermore, we observe the onset of superconductivity in these strained films highlighting the possibility of engineering a topological superconducting state. Our results demonstrate the critical role played by strain in engineering novel topological states in thin film systems for developing next-generation spintronic devices.

Large distal ureteric stone with high burden urothelial cancer of the entire ureter and renal pelvis: a dual pathology

Upper-tract urothelial cancer comprises only 3% of all urothelial cancers. Risk factors include tobacco smoking, recurrent urinary infection, urolithiasis and analgesic abuse. Urolithiasis-induced chronic inflammation leads to urothelial proliferation and eventual malignant transformation. The most common association is reported with squamous cell cancer. A 54-year man under evaluation for right flank pain was diagnosed with a large distal ureteric stone and urothelial cancer of the entire right ureter and renal pelvis. The patient underwent right nephroureterectomy and stone retrieval, with urinary bladder cuff excision and pelvic lymph node dissection. On follow-up, the patient succumbed to disease recurrence with widespread metastasis. Urothelial cancer associated with stone disease is atypical. Long-standing inflammation causing metaplastic and dysplastic changes is a possible hypothesis. Careful assessment of the malignancy should be looked for in patients with long-standing obstruction due to stone disease.

A catalog of associations between rare coding variants and COVID-19 outcomes

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease-19 (COVID-19), a respiratory illness that can result in hospitalization or death. We investigated associations between rare genetic variants and seven COVID-19 outcomes in 543,213 individuals, including 8,248 with COVID-19. After accounting for multiple testing, we did not identify any clear associations with rare variants either exome-wide or when specifically focusing on (i) 14 interferon pathway genes in which rare deleterious variants have been reported in severe COVID-19 patients; (ii) 167 genes located in COVID-19 GWAS risk loci; or (iii) 32 additional genes of immunologic relevance and/or therapeutic potential. Our analyses indicate there are no significant associations with rare protein-coding variants with detectable effect sizes at our current sample sizes. Analyses will be updated as additional data become available, with results publicly browsable at https://rgc-covid19.regeneron.com.

Train-Associated Injuries Pose a Significant Burden on Trauma Care Systems of Emerging Economies

BACKGROUND

The Indian railway system is the fourth largest in the world and causes about 15 deaths every day, due to intentional or unintentional reasons. This study presents a 5-year retrospective analysis of patients injured due to train-associated events, managed at a level-1 trauma center in India.

MATERIALS AND METHODS

Hospital-based trauma registry data of train-associated injuries presenting between 2012 and 2016 were analyzed. Data from 726 patients were analyzed for demographics, injury events, injury regions, their management and outcomes. ISS and NISS were used to quantify the injury severity.

RESULTS

Mean age was 33 years, with male-to-female ratio 86 to 14%. The majority of patients (62%) were between 20-40 years. The median ISS was 9 (IQR 4-16), median hospital stays 11 days (IQR6-23), with in-hospital mortality of 17.4%. Presence of head injury; ISS > 9 and CPR in ED were independent risk factors of mortality. Trespassers on the rail track had significantly more severe injuries compared to passengers (Median ISS 13 vs. 9, p = 0.012; Median NISS 22 vs.17, p = 0.015); however, mortality and hospital length of stay were not significantly different. Location of injury event (on platform or tracks) showed no difference between the severity of injuries, mortality and hospital length of stay.

CONCLUSIONS

Current study reports comprehensive injury patterns and outcomes of train-associated injuries from a low- and middle-income country (LMIC). Apart from the mortality, there is a high incidence of permanent disabilities from extremity amputations. No significant difference was noted in the severity and outcomes among patients injured on or off train platforms, emphasizing the need for comprehensive safety measures including enforcement and promoting safe behavior not only on locations like train tracks but equally at platforms.

Status of salt iodization, related awareness and practice at the household level in slums of Burdwan Municipality, West Bengal

Background:

Monitoring adequacy of salt iodization at consumption level and exploring the reasons for inadequacy, especially in marginalized communities, is crucial to achieve the target coverage of universal salt iodization.

Aims:

To assess the iodine content of salt used at household level, related awareness and practice of respondents and their socio demographic correlates.

Settings and Designs:

This cross-sectional descriptive study was conducted in the slums of Burdwan Municipality in 2019.

Methods and Material:

A total of 330 households were selected by cluster sampling. Salt iodine content was estimated at household level semi-quantitatively by Iodine testing kit, following recommended guidelines. One respondent from each household was interviewed to assess their awareness and practice regarding iodized salt. Kruskal Wallis test, Mann Whitney U test and Multivariable logistic regression was used.

Results:

All 330 households were using iodized salt; 77.6% were consuming adequately iodized and 22.4% were consuming inadequately iodized salts. Only 30.9% of the respondents were aware about the importance of iodized salt, few had correct practice despite inadequate knowledge and none, except one, practiced adding salt at the end of cooking. Awareness and practice were associated with caste and age of the respondents, respectively. Keeping salt container near the oven, adjusting for keeping salt in uncovered container, significantly predicted inadequate level of iodization [AOR 6.17 (95% CI: 2.68-14.26)].

Conclusion:

Inadequate iodization, lack of awareness regarding iodized salt and faulty storing practices amounting to increased risk of inadequate iodization are still prevalent emphasizing the need, in policy, for health education.

Contraceptive behavior and unmet need among the tribal married women aged 15-49 years: A cross-sectional study in a community development block of paschim Bardhaman District, West Bengal

Background

Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions.

Objectives

: This study aimed to ascertain the contraceptive behavior of tribal married women of 15-49 years and to assess the unmet need for family planning and its determinants.

Methods

: A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20.

Results

: All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors.

Conclusion

Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Chronic Pain and Depression: A Community Based Study in a Rural Area of West Bengal

Introduction: Chronic pain is one of the most neglected health problems throughout the world. A close association of depression with chronic pain adds to the burden. There is severe dearth of epidemiological studies regarding depression in chronic pain among general population in India. Aim: To evaluate the prevalence of chronic pain among the selected rural population and to find out association between chronic pain and depression, if any. Materials and Methods: This cross-sectional study was done with the objective of studying the relationships between socio-demographic factors, depression with characteristics of chronic pain among adult population in a community setting. Data was collected from 697 adult (>18 years) chronic pain (>12 weeks duration) sufferers chosen randomly with proportionate representation from all 81 villages of Amdanga block, West Bengal, through a household-based survey in cross-sectional design. A pre-designed, pre-tested structured questionnaire containing socio-demographic information where Brief Pain Inventory (BPI), Patient Health Questionnaire-9 (PHQ-9) and Physical Functional Ability Questionnaire (FAQ-5) were used. During analysis, indices representing perceived pain, impairment and functional ability were generated from the questionnaire by principal component analysis. Results: Low Back Pain (LBP) was found to be significantly higher among females that is 57.7% (p-value=0.022), followed by knee pain (54.8%). Age (p<0.001), Educational level (p<0.001), Income (p<0.001) were found to be significantly associated with perceived pain, impairment, and functional ability, which again show significant monotonic relationship with severity of depression. Major Depressive Disorder (MDD) is found in 9.04% (95% CI: 7.95%-10.13%) of chronic pain sufferers. Conclusion: Frequency of knee pain increases with aging, this points towards its degenerative nature. Perceived pain and impairment get higher while functional ability gets lower as the severity of depression increases.

Status of comprehensive abortion care service in paschim Bardhaman district, West Bengal – A mixed-method study

Background:

Delivering quality comprehensive abortion care (CAC) service, accessible and affordable to all care seekers, at every tier is essential to reduce maternal morbidity and mortality.

Objectives:

The study aimed to assess the infrastructural availability of the health facilities, describe beneficiary characteristics, and to explore constraints in CAC service provision from the providers' perspectives.

Materials and Methods:

A mixed-method study was conducted during December 2019 to February 2020 in Paschim Bardhaman District, West Bengal. All 10 public health facilities of the district providing CAC services were visited for infrastructural assessment. Record review of all care seekers from 2015 to 2018 was done to assess their characteristics. In-depth interview of the administrative heads of facilities and district level program officers was done to explore constraints faced in service provision. Quantitative data were analyzed by SPSS version 20, and qualitative data were analyzed thematically using NVivo software.

Results:

Physical infrastructure was adequate in only 40% of the facilities; however, drugs and contraceptives were universally available. About 49.5% of the care seekers had induced abortion; 63.5% underwent manual vacuum aspiration; 21.5% did not return for follow-up, and only 50% adopted postabortal contraception. Major issues explored were lack of trained manpower, logistics and physical infrastructure, and inadequate supervision and monitoring.

Conclusion:

The study highlighted gaps in preparedness of the health facilities for the provision of quality CAC services including some major constraints from the provider's perspectives.

A randomized trial analyzing the effects of primary versus delayed primary closure of incision on wound healing in patients with hollow viscus perforation

Objectives

Delayed primary closure (DPC) of the skin has been suggested to decrease superficial surgical site infection (SSSI) in patients undergoing surgery for peritonitis secondary to hollow viscus perforation, but there is no consensus. The aim of this study was to compare the outcomes of primary closure (PC) and DPC of the skin in terms of SSSI, fascial dehiscence and length of hospital stay (LOS).

Material and Methods

Sixty patients, undergoing emergency surgery for perforation peritonitis, were randomized to PC (n= 30) and DPC (n= 30). Patients in the DPC group underwent skin closure four or more days after surgery when the wound was clinically considered appropriate for closure. Patients in the PC group had skin closure at the time of surgery.

Results

Incidence of SSSI was significantly less in the DPC group (7.4%) compared to the PC (42.9%) (p= 0.004). However, the median time of DPC was the 10th POD, i.e., these wounds required considerable time to become clinically suitable for closure. Incidence of fascial dehiscence was comparable between the two groups (p= 0.67). Length of hospital stay (LOS) was 13.8 days in the DPC group compared to 13.5 days in PC; the difference was not significant (p= 0.825).

Conclusion

DPC of the skin incision resulted in the reduction of SSSI. However, this did not translate into a reduction in hospital stay, as it took considerable time for these wounds to become appropriate for DPC, thus bringing into question any real advantage of DPC over PC.

High-resolution optical microscopy for characterising microstructural deformation in microtensile testing

Imaging surface deformation of a coupon specimen in microtensile testing with an optical microscope presents challenges due to the narrow depth of field (DoF) of optical microscopes. Materials being heterogeneous at microscopic length scale, the sample surface deforms into a complex 3D surface texture, evolving continuously as the loading increases. Because of the narrow DoF, the region that is in focus within the field of view (FoV) decreases substantially in size with the increasing out-of-plane heterogeneous deformation. To address this challenge, a method based on image blending and stabilisation of the captured image frames is proposed. Image blending combines the partial regions that are in focus from a set of successive image frames captured at different working distances from the object surface plane to construct a single image that has a large part of the FoV in focus. The blended images are then obtained at different levels of macroscopic strains, that is the global homogeneous strain, in order to characterise the evolution of the heterogeneous deformation. The image stabilisation removes any misalignments of the blended images by spatially realigning them choosing a common feature as a reference point. The validation of the proposed method with conventionally and additively manufactured stainless steel 316L (SS 316L) specimens demonstrates excellent improvement in image quality. Almost 100% of the FoV is maintained in focus regardless of the amount of out-of-plane heterogeneous deformation caused during tensile testing, which is quite remarkable for optical microscopy imaging. Consequently, the blended and stabilised images enhanced the accuracy of digital image correlation (DIC). Time-lapse videos of the deformation generated using these images captured the evolution of the slip bands and their transmission through twinning boundaries in the stainless steel microstructure. Overall, this study demonstrates the feasibility of using image-processing techniques to advance optical microscopy to image complex 3D surfaces evolving with time.

Chronic respiratory morbidity in the Bhopal gas disaster cohorts: a time-trend analysis of cross-sectional data (1986-2016)

OBJECTIVES

In 1984, nearly 500,000 inhabitants of Bhopal city, India, were exposed to toxic gases that leaked from a nearby pesticide manufacturing plant. In 1985, four cohorts were established to assess the long-term health impact of exposure, namely, mild, moderate, severely exposed and unexposed groups. The self-reported morbidity data of these cohorts were collected by follow-up cross-sectional surveys at regular intervals over the last 35 years. The present study aimed to analyse the long-term trend of chronic (duration of symptoms >3 months) respiratory morbidity in the four cohorts, stratified by age groups.

STUDY DESIGN

The design of this study is a longitudinal analysis of cross-sectional respiratory morbidity data.

METHODS

Chronic respiratory morbidity data within the cohorts were analysed at 5-year intervals (first recorded data from 1986). Based on age at the time of exposure, subjects were stratified into four age groups: children (aged <10 years), teenagers (aged ≥10 to <20 years), younger adults (aged ≥20 to <40 years) and older adults (aged ≥40 years).

RESULTS

During the first decade, after exposure to the toxic gases, chronic respiratory morbidity in children and teenagers was high (up to 9.1%), which declined thereafter. Progressively increasing chronic respiratory morbidity was observed in both the younger and older adult age groups within all cohorts during the initial 5-10 years after exposure. Respiratory morbidity in both the younger and older adult age groups remained high for 15-20 years and thereafter recorded a declining trend. The highest respiratory morbidity observed during this study in the younger and older adult age groups was 38.6% and 59.5%, respectively; these values were both recorded in the severely exposed cohort.

CONCLUSIONS

Exposure to toxic gases released during the Bhopal gas disaster has resulted in chronic respiratory morbidity of the exposed population; this morbidity has continued over decades. The age of the individuals at the time of exposure and exposure severity were crucial determinants of the long-term trend of respiratory morbidity.

CBETA: First Multipass Superconducting Linear Accelerator with Energy Recovery

Energy recovery has been achieved in a multipass linear accelerator, demonstrating a technology for more compact particle accelerators operating at higher currents and reduced energy consumption. Energy delivered to the beam during the first four passes through the accelerating structure was recovered during four subsequent decelerating passes. High-energy efficiency was achieved by the use of superconducting accelerating cavities and permanent magnets. The fixed-field alternating-gradient optical system used for the return loop successfully transported electron bunches of 42, 78, 114, and 150 MeV in a common vacuum chamber. This new kind of accelerator, an eight-pass energy recovery linac, has the potential to accelerate much higher current than existing linear accelerators while maintaining small beam dimensions and consuming much less energy per electron.

0438 Automatic Nighttime Agitation and Sleep Disruption Detection Using a Wearable Ankle Device and Machine Learning

Introduction

Nighttime agitation behavior such as wandering and restlessness during awake and sleep in people with Alzheimer’s disease (AD) is expensive to manage and adversely affects sleep. Nighttime agitation is mostly noted by subjective caregiver reports. An automated process for this assessment would improve clinical management. Here we report on the RestEaZeTM system that uses an ankle band and machine learning to automatically classify sleep status and nighttime agitation behaviors in older adults with AD.

Methods

We collected data on 7 adults (mean: 81 years, SD: 10.6) with AD. They wore the RestEaZeTM ankle band with a 3-axis accelerometer, a 3-axis gyroscope, and three textile capacitive sensors. A trained Research Assistant (RA) continuously observed for wandering, restlessness, wake, and sleep between 5pm and 7am using the Cohen Mansfield Agitation Inventory (CMAI). We merged, and band-pass filtered the data and divided it into 10-second non-overlapping windows. CMAI labels and time-series features (scaled using StandardScaler) extracted from the RestEaZeTM data were used to train a Random Forest binary classifier. The significant features were extracted based on the impact on the p-value for the classifier. We used the Synthetic Minority Oversampling Technique (SMOTE) to balance the dataset and performed 5-fold cross-validation with a 67-33 train-test split.

Results

We report the sensitivity, specificity, accuracy, and Area-under-the Curve (AUC) for the ROC curve for the classifiers: (1) Sleep/Awake: sensitivity=0.95, specificity=0.87, accuracy=0.92, AUC=0.97; (2) Wandering/Non-Wandering: sensitivity=0.85, specificity=0.99, accuracy=0.98, AUC=0.99; and (3) Restless/Non-Restless: sensitivity=0.84, specificity=0.84, accuracy=0.84, AUC=0.92. The significant features were related to the intensity of movements.

Conclusion

Our preliminary results show the feasibility of using RestEaZeTM for quantitatively measuring nighttime agitation. These can provide clinically useful objective measures of agitation that can be automatically transmitted to clinical or research records with minimal staff time requirements.

Support

The authors acknowledge the funding support from the National Institute on Aging under award R01AG051588 and Arbor Pharmaceuticals for support for Horizant and the matching placebo.

Compartment syndrome of the non-injured limb

Compartment syndrome is a common limb-threatening entity in trauma. However, the occurrence of the same in the non-injured limb is rare. It seems to be multifactorial in origin, with abnormal positioning being the most common cause. We present such a case of well-leg compartment syndrome which was treated by an urgent fasciotomy. We emphasise on the fact that the diagnosis of compartment syndrome is clinical and the management remains the same irrespective of whether the limb has sustained an injury or not.

Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern

Objective:

A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant.

Materials and Methods:

A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities.

Results:

Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant.

Discussion and Conclusion:

By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study

Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty-six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer-generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In-hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train-associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.

Post-traumatic bronchobiliary fistula

Post-traumatic bronchobiliary fistula (BBF) is a rare entity, with only a few cases reported worldwide. Bilioptysis is pathognomonic of the condition, however, bronchoscopy and bronchoalveolar lavage along with CT are used for confirmation. We describe this condition in a young woman who presented to us with bilioptysis following a laparotomy for blunt torso trauma. Diagnosis was made of BBF, followed by surgical management and complete recovery. We emphasise the signs of early diagnosis, confirmatory tests, individualised treatment and advocate surgical management as the gold standard of treatment.

Analysis of differentially methylated regions in great apes and extinct hominids provides support for the evolutionary hypothesis of schizophrenia

INTRODUCTION

The persistence of schizophrenia in human populations separated by geography and time led to the evolutionary hypothesis that proposes schizophrenia as a by-product of the higher cognitive abilities of modern humans. To explore this hypothesis, we used here an evolutionary epigenetics approach building on differentially methylated regions (DMRs) of the genome.

METHODS

We implemented a polygenic enrichment testing pipeline using the summary statistics of genome-wide association studies (GWAS) of schizophrenia and 12 other phenotypes. We investigated the enrichment of association of these traits across genomic regions with variable methylation between modern humans and great apes (orangutans, chimpanzees and gorillas; great ape DMRs) and between modern humans and recently extinct hominids (Neanderthals and Denisovans; hominid DMRs).

RESULTS

Regions that are hypo-methylated in humans compared to great apes show enrichment of association with schizophrenia only if the major histocompatibility complex (MHC) region is included. With the MHC region removed from the analysis, only a modest enrichment for SNPs of low effect persists. The INRICH pipeline confirms this finding after rigorous permutation and bootstrapping procedures.

CONCLUSION

The analyses of regions with differential methylation changes in humans and great apes do not provide compelling evidence of enrichment of association with schizophrenia, in contrast to our previous findings on more recent methylation differences between modern humans, Neanderthals and Denisovans. Our results further support the evolutionary hypothesis of schizophrenia and indicate that the origin of some of the genetic susceptibility factors of schizophrenia may lie in recent human evolution.

Recently evolved human-specific methylated regions are enriched in schizophrenia signals

Background

One explanation for the persistence of schizophrenia despite the reduced fertility of patients is that it is a by-product of recent human evolution. This hypothesis is supported by evidence suggesting that recently-evolved genomic regions in humans are involved in the genetic risk for schizophrenia. Using summary statistics from genome-wide association studies (GWAS) of schizophrenia and 11 other phenotypes, we tested for enrichment of association with GWAS traits in regions that have undergone methylation changes in the human lineage compared to Neanderthals and Denisovans, i.e. human-specific differentially methylated regions (DMRs). We used analytical tools that evaluate polygenic enrichment of a subset of genomic variants against all variants.

Results

Schizophrenia was the only trait in which DMR SNPs showed clear enrichment of association that passed the genome-wide significance threshold. The enrichment was not observed for Neanderthal or Denisovan DMRs. The enrichment seen in human DMRs is comparable to that for genomic regions tagged by Neanderthal Selective Sweep markers, and stronger than that for Human Accelerated Regions. The enrichment survives multiple testing performed through permutation (n = 10,000) and bootstrapping (n = 5000) in INRICH (p < 0.01). Some enrichment of association with height was observed at the gene level.

Conclusions

Regions where DNA methylation modifications have changed during recent human evolution show enrichment of association with schizophrenia and possibly with height. Our study further supports the hypothesis that genetic variants conferring risk of schizophrenia co-occur in genomic regions that have changed as the human species evolved. Since methylation is an epigenetic mark, potentially mediated by environmental changes, our results also suggest that interaction with the environment might have contributed to that association.

Electronic supplementary material

The online version of this article (10.1186/s12862-018-1177-2) contains supplementary material, which is available to authorized users.

Magnetic coupling at rare earth ferromagnet/transition metal ferromagnet interfaces: A comprehensive study of Gd/Ni

Thin film magnetic heterostructures with competing interfacial coupling and Zeeman energy provide a fertile ground to study phase transition between different equilibrium states as a function of external magnetic field and temperature. A rare-earth (RE)/transition metal (TM) ferromagnetic multilayer is a classic example where the magnetic state is determined by a competition between the Zeeman energy and antiferromagnetic interfacial exchange coupling energy. Technologically, such structures offer the possibility to engineer the macroscopic magnetic response by tuning the microscopic interactions between the layers. We have performed an exhaustive study of nickel/gadolinium as a model system for understanding RE/TM multilayers using the element-specific measurement technique x-ray magnetic circular dichroism, and determined the full magnetic state diagrams as a function of temperature and magnetic layer thickness. We compare our results to a modified Stoner-Wohlfarth-based model and provide evidence of a thickness-dependent transition to a magnetic fan state which is critical in understanding magnetoresistance effects in RE/TM systems. The results provide important insight for spintronics and superconducting spintronics where engineering tunable magnetic inhomogeneity is key for certain applications.

Abstract P6-03-08: Novel recurrent lncRNA fusions detected in breast cancer using RNA-Seq technology in a neoadjuvant setting

Background: Recent discoveries of recurrent and targetable gene fusions in breast cancer suggest the need to characterize the functional significance of such genomic aberrations within larger cohorts. We quantified fusion transcript expression in patient samples using RNASeq to identify recurrent gene fusion events in breast cancer as well as study the fusions post-brief exposure to mono-therapy.

Methods: We sequenced transcriptomes of core biopsy RNA from 130 breast tumors obtained from brief-exposure preoperative clinical trials BrUOG 211A/211B. HER2- patients were treated with brief exposure to bevacizumab (B) or nab-paclitaxel (nP) followed by treatment with B/nP/carboplatin while HER2+ patients received brief exposure to trastuzumab (T) or nP followed by T/nP/carboplatin. Paired-end sequencing on 75 baseline biopsies and 55 post-exposure biopsies using amplified total RNA yielded 55 million reads on average perlsample. Fusion transcript abundance was evaluated using 2 pipelines, TopHat-Fusion and deFuse, due to their complementary strategies in fusion detection. We eliminated gene-pseuodogene fusion pairs as likely false positives arising due to alignment artifacts. Fusions that met 1 or more of the following 3 criteria were considered high confidence:

i) Called by both deFuse and TopHat. ii) Called by deFuse with probability &gt;95% iii) Called by TopHat with &gt; 15 reads supporting the fusion.

Results: We identified high confidence gene fusions, detected by both TopHat and deFuse, in 73 of the 75 baseline biopsies with 16 fusions on average per sample. We looked for modulation of gene fusions upon brief exposure to therapy in 55 patients that had post exposure biopsy data and found that out of the 545 high confidence fusions detected across these patients, 62 (11.37%) of the fusions were found to be still present after the therapy exposure. For the recurrent fusion analyses, we considered the 75 baseline samples. We found a total of 1158 unique candidate fusions. Out of these, 116 (10%) were recurrent in more than 1 patient. After further filtering, we were able to narrow down to 9 (0.77%) fusions that were reliable since they were predicted by both the algorithms in different patients. 2 of these 9 fusions involved GAS5 as a partner gene. GAS5 have been studied to have a role in apoptosis and its down-regulation has been associated with cell proliferation, which makes it a very interesting fusion candidate.

Conclusions: We find that gene fusions in breast cancer are highly heterogeneous but are enriched with cancer-related pathway genes. This is the first study to report 2 novel gene-lincRNA fusion transcripts: MDN1-GAS5 and GABRB3-GAS5. Both these fusions are called in the baseline & post-therapy for atleast 1 patient (different patients each). GAS5 has been found as participating in a fusion in B-cell lymphoma. We are currently in the process of validating the fusion calls using qRT-PCR. The heterogeneity of detected fusions suggests that multiple mechanisms could underlie the selective advantage of tumor cells expressing fusion transcripts. The brief-exposure preoperative paradigm provides a unique opportunity to evaluate modulation of fusion transcripts that can shed light on their functional importance.

Citation Format: Agrawal V, Varadan V, Banerjee N, Miskimen K, Vadodkar A, Abu-Khalaf M, Sikov W, Harris L, Dimitrova N. Novel recurrent lncRNA fusions detected in breast cancer using RNA-Seq technology in a neoadjuvant setting. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-03-08.

Microballoon pressure sensors for particle imaging manometry in liquid and gaseous media

We present the fabrication and testing of engineered microballoon particles that expand and contract under external pressure changes hence serving as microscopic pressure sensors. The particles consist of 12 μm hollow flexible 0.4 μm-thick parylene-C shells with and without a coating of ultrathin Al2O3 diffusion barriers, and the changes in the particle radius are measured from the particle spectral reflectivity. The microballoons display radial pressure sensitivities of 0.64 nm psi(-1) and 0.44 nm psi(-1), respectively in agreement with theoretical estimates. The microballoon devices were used for mapping the internal pressure drop within microfluidic chips. These devices experience nearly spherical symmetry which could make them potential flow-through sensors for the augmentation of particle-based flow characterization methodologies extending today's capabilities of particle imaging velocimetry.

Flexoelectric MEMS: towards an electromechanical strain diode

Piezoelectricity and flexoelectricity are two independent but not incompatible forms of electromechanical response exhibited by nanoscale ferroelectrics. Here, we show that flexoelectricity can either enhance or suppress the piezoelectric response of the cantilever depending on the ferroelectric polarity and lead to a diode-like asymmetric (two-state) electromechanical response.

Particle-based optical pressure sensors for 3D pressure mapping

This paper presents particle-based optical pressure sensors for in-flow pressure sensing, especially for microfluidic environments. Three generations of pressure sensitive particles have been developed- flat planar particles, particles with integrated retroreflectors and spherical microballoon particles. The first two versions suffer from pressure measurement dependence on particles orientation in 3D space and angle of interrogation. The third generation of microspherical particles with spherical symmetry solves these problems making particle-based manometry in microfluidic environment a viable and efficient methodology. Static and dynamic pressure measurements have been performed in liquid medium for long periods of time in a pressure range of atmospheric to 40 psi. Spherical particles with radius of 12 μm and balloon-wall thickness of 0.5 μm are effective for more than 5 h in this pressure range with an error of less than 5%.

Plexiform angiomyxoid myofibroblastic tumour of the duodenum: a rare entity

Plexiform angiomyxoid myofibroblastic tumour (PAMT) has recently emerged as a new entity among gastrointestinal mesenchymal tumours. All of the 27 cases reported until now originated from the stomach. We report the first case of a duodenal PAMT arising from the first part of the duodenum in a 19-year-old woman presenting with upper abdominal pain and an abdominal lump.

Neurotransmitters in alcoholism: A review of neurobiological and genetic studies

Recent advances in the study of alcoholism have thrown light on the involvement of various neurotransmitters in the phenomenon of alcohol addiction. Various neurotransmitters have been implicated in alcohol addiction due to their imbalance in the brain, which could be either due to their excess activity or inhibition. This review paper aims to consolidate and to summarize some of the recent papers which have been published in this regard. The review paper will give an overview of the neurobiology of alcohol addiction, followed by detailed reviews of some of the recent papers published in the context of the genetics of alcohol addiction. Furthermore, the author hopes that the present text will be found useful to novices and experts alike in the field of neurotransmitters in alcoholism.

Abstract P4-04-07: Heterogeneous gene fusions detected by RNASeq show enrichment of insulin signaling pathway genes in breast cancer

Background: Recent discoveries of recurrent and targetable gene fusions in breast cancer suggest the need to characterize the functional significance of such genomic aberrations within larger cohorts. We quantify fusion transcript expression in patient samples using RNASeq and evaluate their functional significance using biological pathway enrichment analysis.

Methods: We sequenced transcriptomes of core biopsy RNA from 97 breast tumors obtained from brief-exposure preoperative clinical trials BrUOG 211A/211B. HER2- patients were treated with brief exposure to bevacizumab (B) or nab-paclitaxel (nP) followed by treatment with B/nP/carboplatin while HER2+ patients received brief exposure to trastuzumab (T) or nP followed by T/nP/carboplatin. Paired-end sequencing on 55 baseline biopsies and 42 post-exposure biopsies using amplified total RNA yielded 55 million reads on average per sample. We assigned RNASeq-based PAM50 subtypes for each of the samples using standard methodology. Fusion transcript abundance was evaluated using two independent pipelines, TopHat and deFuse, due to their complementary strategies in fusion detection. We eliminated fusions of genes with their respective pseudogenes as likely false positives arising due to alignment artifacts. TopHat fusion calls with total supporting reads ≥10 and deFuse calls with probability of fusion ≥0.7 were considered reliable.

Results: We identified high confidence gene fusions, detected by both TopHat and deFuse, in 30 of the 55 baseline biopsies (54.4%), with 3.3 fusions on average per sample and a maximum of 10. Fusions were predominantly associated with chromosomal aberrations (75%), with putative deletions responsible for 32% of fusions and translocations responsible for 43%. We find a high level of fusion transcript heterogeneity within breast cancers, detecting a total of 80 fusions across the 30 samples with only three fusions recurrent in two samples with high expression in each: MDN1-GAS5 in two basal breast cancers, KRAS-GRIP1 and ITPR2-CCDC91 in two LumB cancers. Several cancer-related genes were found to be fusion partners: AKT3-SMYD3, CREB1-PPP1R1C, FLOT2-TOP2A and FOXC1-ARID1B. Pathway analysis of the fusion genes at baseline revealed enrichment of proteasome (p = 0.000752), tight junction (p = 0.027), insulin signaling (p = 0.0284) and melanogenesis (p = 0.05) pathways after multiple testing correction (FDR≤0.25). We looked for modulation of gene fusions upon brief exposure to therapy in 18 patients and found a majority of the baseline fusion transcripts to be present post-brief exposure in 44% of the patients, irrespective of therapy regimen.

Conclusions: We find that gene fusions in breast cancer are highly heterogeneous but are enriched with cancer-related pathway genes. This is the first study to report a novel gene-lincRNA fusion transcript (MDN1-GAS5). We are currently validating the fusion calls using qRT-PCR. The heterogeneity of detected fusions suggests that multiple mechanisms could underlie the selective advantage of tumor cells expressing fusion transcripts. The brief-exposure preoperative paradigm provides a unique opportunity to evaluate modulation of fusion transcripts that can shed light on their functional importance.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-04-07.